& 


I 


, 


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FIG.  1.  Radiograph  of  a  lesion  of  the  second  dorsal  vertebra.  Note  the 
approximation  of  the  left  transverse  processes  of  the  first  and  second 
dorsal  vertebrae.  Case  of  exophthalmic  goitre  following  traumatic 
strain  in  this  spinal  area.  Recovery. 


PRINCIPLES  of 
OSTEOPATHY 

By  DAIN   L.  TASKER,    D.  O. 


MEMBER  OF  THE  FACULTY  OF  THE  PACIFIC 

COLLEGE  OF  OSTEOPATHY 

1898-1907 

FELLOW   OF   THE  SOUTHERN    CALIFORNIA 
ACADEMY  OF  SCIENCES 

PRESIDENT   OF  THE   CALIFORNIA  STATE 

BOARD  OF  OSTEOPATHIC  EXAMINERS 

1901-1902 

PRESIDENT  OF  THE  CALIFORNIA   STATE 

BOARD  OF  MEDICAL  EXAMINERS 

1910-1911 

MEMBER  OF  THE  AMERICAN   OSTEOPATHIC 
ASSOCIATION 


Third  Edition  Revised — Illustrated 


PUBLISHED   BY 

BIRELEY  a  ELSON  PRINTING  CO. 
LOS  ANGELES,  CAL. 


COPYRHiHTKl)    1913    BY    THE    AI'THOR. 

DAIN  L.  TASKKR,  D. O. 

LOS    ANIiBLES,   CALIFORNIA. 


PREFACE. 

This  book  on  the  Principles  of  Osteopathy  is  intended 
as  a  manual  for  the  use  of  students  and  practitioners. 
There  has  been  no  effort  on  the  part  of  the  author  to  do 
more  than  give  a  short,  terse  exposition  of  the  essential 
facts  underlying'  osteopathy.  Realizing  fully  the  great 
effort  required  to  keep  pace  with  the  rapid  progress  of 
medicine  in  general,  we  have  tried  to  include  in  our  chap- 
ters only  that  which  will  be  solid  food  for  our  readers.  We 
have  long  since  learned  that  the  hurried  student  and  busy 
practitioner  have  no  time  to  read  long  dissertations  on 
any  subject.  Time  is  an  essential  factor  in  covering  the 
necessary  studies  of  an  osteopathic  curriculum. 

In  order  that  the  student  may  read  these  chapters 
intelligently  he  must  have  concluded  at  least  ten  months 
study  of  Biology,  Histology,  Anatomy  and  Physiology. 
These  subjects  form  the  basis  of  the  science  of  osteopathy. 

The  author  has  kept  in  touch  with  the  growth  of  osteo- 
pathy from  year  to  year  through  careful  perusal  of  its  pub- 
lished books  and  periodicals. 

The  contents  of  this  book  are  the  condensed  results 
of  the  author's  study  of  recognized  medical  text  books  on 
Anatomy,  Physiology,  Histology,  Pathology,  Bacteriology 
and  Diagnosis,  of  the  works  of  the  founder  of  Osteopathy, 
Dr.  A.  T.  Still,  Hazzard,  Riggs,  Henry  and  McConnell ;  of 
six  years'  experience  in  the  clinics  of  the  Pacific  School  of 
Osteopathy,  and  the  Infirmary  in  connection  with  this 
college,  and  six  years  of  continuous  teaching,  two  of  which 
were  devoted  to  Anatomy  and  Physiology  and  the  remain- 


8  PREFACE 

ing  four  to  Theory  and  Practice  of  Osteopathy  and  Physi- 
cal Diagnosis. 

To  enumerate  the  books  from  whose  pages  facts  have 
been  gleaned  for  corroborative  testimony  concerning  the 
Principles  of  Osteopathy  is  impossible.  Books  have  been 
read  and  laid  aside  and  what  is  here  written  may  be  the 
result  of  something  which  caught  the  author's  attention 
for  a  moment  only  and  then  became  a  maverick. 

The  illustrations  to  elucidate  the  text  have  been  fur- 
nished principally  by  the  laboratories  and  clinics  of  the 
Pacific  School  of  Osteopathy.  Without  the  hearty  and 
efficient  aid  of  my  associates  on  the  faculty  of  this  college 
much  of  the  concise  detail  of  this  book  would  have  been 
impossible.  I  am  indebted  to  several  osteopathic  physi- 
cians for  drawings  of  histological  tissues  which  they  had 
prepared  during  their  college  work.  They  are  given  credit 
under  their  drawings. 

The  large  number  of  excellent  photographs  of  micro- 
scopic structures,  patients  and  movements  is  the  result 
of  the  skill  of  J.  O.  Hunt.  D.  O.  A  few  of  the  photographs 
were  made  by  M.  E.  Sperry.  D.  O.,  who  also  took  great 
care  to  see  that  we  had  the  best  of  photographic  lenses 
with  which  to  work.  I  am  also  greatly  indebted  to  C.  H. 
Phinney,  D.  O..  and  J.  E.  Stuart,  D.  O.,  for  their  accurate 
demonstration  of  osteopathic  movements. 

My  thanks  are  extended  to  Miss  Louisa  Burns,  B.  S., 
for  reading  the  manuscript  and  suggesting  corrections 
therein,  also  to  Miss  Gertrude  Smith  for  preparing  the 
manuscript  for  the  publisher. 

DAIN  L.  TASKER,  D.  O. 


PREFACE  9 

PREFACE  TO  THIRD  EDITION. 

A  long  time  has  elapsed  since  the  second  edition  of 
this  book  was  sold  out.  The  present  edition  is,  in  reality, 
a  new  book  instead  of  what  is  ordinarily  understood  as  a 
revision.  The  material  which  was  developed  for  the  first 
and  second  editions  was  entirely  destroyed  by  the  dyna- 
mite explosion  and  fire  which  wrecked  the  great  estab- 
lishment of  the  Los  Angeles  Times  and  killed  more  than  a 
score  of  its  employees. 

The  demand  for  this  book  having  grown  steadily 
more  insistent  and  the  more  important  fact  that,  during 
the  time  since  the  publication  of  the  second  edition,  there 
has  been  a  great  development  in  every  phase  of  osteopathic 
teaching  and  practice,  has  led  us  to  attempt  to  produce 
an  edition  of  Principles  of  Osteopathy  which  will  be  even 
more  useful  to  students  and  practitioners  than  our  former 
editions. 

The  experimental  work  done  in  the  laboratories  of 
our  colleges  and  of  private  investigators,  as  well  as  the 
recorded  experiences  of  our  practitioners,  tend  more  and 
more  to  substantiate  the  Principles  of  Osteopathy  as  set 
forth  in  our  previous  editions.  The  feeling  that  this  book 
will  furnish  genuine  assistance  in  the  teaching  and  prac- 
tice of  osteopathy  leads  the  author  to  send  it  forth,  with 
the  belief  that  its  imperfections  will  be  kindly  excused  by 
its  readers,  in  view  of  the  spirit  of  generous  helpfulness 
toward  all  schools  of  medicine  which  has  been  made  the 
reason  for  its  existence. 

Nearly  every  chapter  is  in  some  degree  changed  or 
completely  rewritten.  Several  new  chapters,  of  practical 
value,  have  been  added.  Much  of  the  material  in  early 
chapters  of  the  former  editions,  relating  to  histology,  has 
been  eliminated. 

The  writer  wishes  to  express  his  gratitude  to  John 
Comstock  for  his  valuable  assistance  in  illustrating  this 
edition. 


TABLE  OF  COXTKXTS 


CHAPTER  I— Causes  of  Disease 

Normal  and  Abnormal — The-  Ideal  Normal — Variations  in 
Structure  and  Function — Adaptation — Normal  Health — Comfort 
and  Efficiency — Variation  of  the  Normal — Distress  and  Ineffi- 
ciency—  Difference  in  Belief  as  to  Causes — Interpretation  of 
Phenomena  of  Disease — Favorable  Reaction  to  Environment — 
Known  Causes  of  Disease — The  Tenacity  of  Life — Lesion- 
Disease  Association — Remove  the  Cause  of  Disease — Preven- 
tative  Medicine — Symptoms — A  Normal  Stimulus — A  Change 
of  Resistance — Cause  and  Fffcct — Cell  Relations — I^xcessive 
Stimulation — Structural  Defects — Cell  Life  Dependent  on  Cir- 
culation—  Intercellular  Tension — Scientific  Therapeutics — The 
Problem  as  a  Whole — Natural  Recovery — Extrinsic  Causes  of 
Disease — Inherent  Recuperative  Power — Disturbed  Tissue  Re- 
lations— The  Biological  Relation  of  Function  and  Structure — 
The  True  Art  of  Healing. 

CHAPTER  II — The  Lesion  as  a  Cause  40 

Definition — Characteristics  of  a  Lesion — Classes  of  Lesions — 
Causes  of  Lesions — Secondary  Lesions — Effect  of  Violence  or 
Fatigue — Failure  of  Adaptation — Chemical  Causes  of  Spinal 
Lesions — The  Reason  for  the  Persistance  of  a  Lesion — The 
Sequence  of  Lesion  Phenomena — Variations  in  Development — 
Palpation  of  a  Lesion — Description — Find  the  Lesion — Inspec- 
tion of  the  Back — Palpation  of  Vertebral  Structures — History 
of  Accident — Traumatic  Lesion — Weight  Carrying  and  Balanc- 
ing Function  Disturbed — Lack  of  Physiological  Rest — Influence 
on  Circulation  and  Innervation — Segmental  Co-ordination — 
Example  of  Fatigue — Loss  of  Muscular  Tone — Experimental 
Lesions — Loss  of  Motion — Necessity  for  Study  of  Structure. 

CHAPTER  III— The  Lesion  as  an  Effect  55 

Analysis  of  the  Causes  of  Lesions— The  Attractiveness  of  the 
Traumatic  Lesion  Theory — Classification  of  Lesions — Examples 
of  Secondary  Lesions — The  Spinal  Lesion,  an  Objective  Symp- 
tom— Visceral  Reflexes — Pleurisy — Cardiac  Lesion  Patterns — 
LTnity  of  the  Body. 

CHAPTER  IV— Spinal  Hyperaesthesia  and  Muscular  Tension       59 

Subjective  Symptoms — Irritation  of  the  Spinal  Nerves — Spinal 
Treatment — Control  of  the  Body  by  the  Nervous  System — A 
Concept  of  the  Nervous  System — Neuralgia — Visceral  Disturb- 
ance Due  to  Disturbed  Nerve  Control — Co-existence  of  Spinal 


TABLE  OF  CONTENTS  11 

Tenderness — Symptoms  of  Spinal  Irritation — Duration  of  Affec- 
tions Due  to  Spinal  Irritation — Affection  of  the  Upper  Cervical 
Region — Irritation  of  the  Lower  Cervical  Region — Irritation  of 
the  Upper  Dorsal  Region — Irritation  of  the  Lower  Dorsal 
Region — Irritation  of  the  Lumbar  and  Sacral  Regions — The 
Effect  of  Recumbency — Irritation  of  Spinal  Marrow  Not  Neces- 
sarily Dependent  on  Disease  of  Vertebrae — Lateral  Curvature 
—Treatment — Ganglia  of  the  Sympathetic  Nerves — Symptoms 
of  Irritation  of  Sympathetic  Ganglia — Middle  and  Lower  Tho- 
racic Sympathetic  Ganglia — Spinal  Treatment,  Hyperaemia — 
Muscular  Tension — Digital  Examination  of  the  Spinal  Area — 
The  Use  of  Spinal  Muscular  Tension  in  Diagnosis — Cause  or 
Effect. 

CHAPTER  V — The  Segmentation  of  the  Body  76 

The  Lesion  as  a  Guide  in  Diagnosis — The  Spinal  Segment — 
Injury  of  a  Single  Nerve — A  Unilateral  Cervical  Spinal  Lesion 
— Treatment — Involvement  of  the  Central  Nerve  Cells — Cervical 
Muscles — Embryology — Segmentation — Widespread  Influence 
of  a  Spinal  Lesion— Association  of  Muscles  Innervated  by  the 
Same  Segment — Effect  of  Sectioning  Single  Spinal  Nerve — 
Developmental  Changes  in  Muscles. 

CHAPTER  VI— The  Nervous  System  97 

The  Medium  of  Communication — The  Attributes  of  Nerve  Tis- 
sue—Nerve and  Muscle  Irritability — Conductivity — Trophicity 
— Unity  of  the  Nervous  System — Other  Systems  of  Integration 
— Mechanical  Irritation — Effect  on  Conductivity — Afferent  and 
Efferent  Fibres — Organization  of  the  Nerve  Bundle — Intra- 
spinal  Fibers — Segmentation  of  the  Spinal  Cord — Segmental  In- 
tegration— Ceaseless  Play  of  Reflexes — The  Simple  Reflex — The 
Sensory  Side  of  the  Reflex  Arc — Protective  Reactions — Exam- 
ple— Comparative  Segmentation — Efferent  Impulses — Efferent 
Fibers  to  the  Sympathetic  Ganglia — Ganglionic  Control — Three 
Fields  for  Reception  of  Sensory  Impressions — Proprio-ceptive 
Field — Segmental  Co-ordination — Plurisegmental  Control — 
Clinical  Evidence,  Group  Lesions — Differentiation  of  Spinal 
Lesions — Lesions  Due  to  Functional  Fatigue. 

CHAPTER  VII— The  Nervous  System  (Continued)  114 

Alignment,  Tone,  Reflexes — Clinical  Illustration — Inspection — 
Patellar  Tendon  Reflex — Gastric  Spinal  Reflex — Sensation — 
Visceral  Sensation — Dependence  on  Objective  Symptoms — 
Depth  and  Extent  of  Lesions — Lesion  Picture  in  Autotoxemia 
— Lesions  Independent  of  Segmental  Reflexes — The  Lesion  as 
an  Expression  of  Some  Form  of  Integration — Circulatory  Inte- 
gration Lesion — Protective  Reactions — Pains  Incident  to  Chill 
and  Fever — The  Practical  Use  of  Knowledge. 

CHAPTER  VIII— The   Sympathetic  Nervous   System  125 

Unity  of  the  Nervous  System — Origin — Lateral  Ganglia — Four 
Prevertebral  Plexuses  —  Visceral  Ganglia  —  Communicating 
Fibers — White  Rami-communicantes — Distribution — Function — 


12  TABLE  OF  CONTEXTS 

Gray  Rami-communicantes — Distribution — Functions  of  the 
Sympathetic  System— Independent  or  Dependent — Ganglia- 
Cervical  Ganglia  of  Importance  to  Osteopaths — Superior  Cervi- 
cal Ganglion — Connections — Vaso-constriction — Distribution — 
Headache— Middle  Cervical  Ganglion— Distribution— Function 
—  Manipulation — Recapitulation — The  Thoracic  Ganglia — Rami- 
efferentes — I'pper  Five  Thoracic  Ganglia — Xerve  Distribution 
—The  Interscapular  Region— A  Case  Illustrating  the  Ciliospinal 
Center — Effects  of  Treatment,  First  to  Seventh  Dorsal — Great 
Splanchnic — Lesser  Splanchnic — Least  Splanchnic — Functions 
—Theory — Lumbar  Ganglia — Sacral  Ganglia — Distribution — 
Function — Cardiac  Plexus — Position  and  Formation — Pulmo- 
nary Plexus  — Physiology  — Functions  — Treatment  — Results — 
Argument — Solar  Plexus — Location  and  Formation — Distribu- 
tion—  Function — Centers — Hypogastric  Plexus — Location  and 
Formation — Pelvic  Plexus — Distribution — Subsidiary  Plexuses 
— Function — Summary — Automatic  Visceral  Ganglia — Conclu- 


CHAPTER  IX— Circulatory  Tissue  149 

Functions — Lymph — Distribution  of  the  Blood — The  Circulatory 
Apparatus — The  Heart — Regulation  of  Contraction — Co-ordi- 
nating Centers — The  Pneumogastric  Xerve— Accelerator  Cen- 
ter— Stimulation  of  the  Heart — Inhibition  of  the  Heart — Vaso- 
motor  Control  of  the  Coronary  Arteries — Angina  Pectoris — 
Action  of  the  Heart  Centers — Vaso-motor  Xerves — Vaso-con- 
striction— Vaso-dilation — Summary — Sensory  Xerves — Capillary 
Circulation — Recapitulation — Vaso-motor  Centers — Conclusions 
— Hyperaemia — Therapeutics — Case  Illustrations. 

CHAPTER  X— Hilton's  Law  181 

The  Law  Stated — Methods  of  Studying  Anatomy — Example  of 
Hilton's  Law — The  Knee — Object  of  such  a  Distribution — Uni- 
formity of  the  Law — Precision  of  Xerve  Distribution  to  Muscles 
—  Indications  for  the  Use  of  Therapeutics — The  Use  of  Hil- 
ton's Law  in  Physical  Diagnosis — Comparison  of  Methods — 
Herpes  Zoster — The  Distribution  of  an  Intercostal  Xerve — 
Some  of  the  Evil  Effects  of  Rest — Head's  Law — Application  of 
the  Law — The  Viscera — Xerves  of  Conscious  Sensation. 

CHAPTER  XI— Osteopathic  Centers  194 

Diagnosis — First  Four  Cervical  Nerves — Example  of  Hilton's 
Law — The  Pneumogastric  Xerve — The  Hypoglossal  Nerve — 
Superior  Cervical  Ganglion — Suboccipital  Triangles — Cervical 
Plexus — Intensity  of  Reflexes — The  Spinal  Accessory — The 
Phrenic  Xerve,  Hiccoughs — The  Trapezius  and  Splenius  Capitis 
et  Colli  Muscles — Vaso-motion,  Head.  Face  and  Xeck — Affec- 
tions of  the  Cervical  Xerves — Brachial  Plexus — Affections  of  the 
Brachial  Xerves — A  Case  of  Hemiparesis  below  the  Fifth  Cer- 
vical Vertebra — Subluxation  of  the  Scapula — The  Xerve  of 
\\risberg — The  Interscapular  Region — The  Lung  Center — Cilio- 
spinal Center — Heart  Center — Stomach  Center — Liver  and 
Spleen  Center — Large  Intestine — Small  Intestine — Center  for 
Chills — The  Language  of  Pain — Osteopathic  view  of  Pathology 


TABLE  OF  CONTENTS  13 

— Center  for  the  Gall-bladder — Intestines — Uterus — Ovaries  and 
Testes — Kidney — Second  Lumbar — Paraplegia — Lumbar  and 
Sacral  Plexuses — The  Bladder — Sphincter  Vaginae — Conclu- 
sions. 

CHAPTER  XII— The  Back  239 

The  Spinal  Column — The  Spinal  Ligaments — Flexibility — Nor- 
mal Spinal  Curves — Limitation  of  Flexibility — Articular  Pro- 
cesses— Cervical  Region — Dorsal  Region — Lumbar  Region — 
Flexion  and  Extension— Side  Bending  Rotation — Best  Position 
for  Freest  Movement — Rotation  in  the  Dorsal  Region — Char- 
acteristic Movement  in  the  Lumbar  Region — Rotation  Toward 
Concavity  of  a  Curve — Adaptability  of  Position  to  Body  Weight. 

CHAPTER  XIII— The  Pelvis  263 

The  Fifth  Lumbar — Loss  vs.  Exaggeration  of  Normal  Curves 
—Motion  in  Lumbo-sacral  Articulation — Adaptation  in  Lumbo- 
sacral  Articulation — Stability  of  the  Lumbo-sacral  Articulation 
— Decompensation  of  the  Lumbro-sacral  Articulation — Part  of 
the  Pelvis — Characteristics  of  the  Sacro-iliac  Articulation — Phys- 
iological Relaxation — The  Male  Pelvis — Loss  of  Stability — 
Analysis  of  Sacro-iliac  Articulations — Relation  of  Sex  to  Sacro- 
iliac  Lesions — Inherent  Weakness  in  the  Character  of  the  Struc- 
ture— Causes  of  Subluxations — Rotation — Compensatory  Pelvic 
Tilt — Classes  of  Cases — Symptoms — Plan  of  Treatment. 

CHAPTER  XIV— Subluxations  283 

Definition — Characteristics  of  Subluxations — Primary  or  Sec- 
ondary Lesions — The  Characteristic  Structure  of  Joints — The 
Atlas — Occipito-atlantal  Articulation — The  Causes  of  Subluxa- 
tions— Normal  Relations  of  the  Atlas — Abnormal  Positions  of 
the  Atlas — The  Effect  of  Muscle  Contraction — The  Effect  on 
Circulation — Effect  on  Superior  Cervical  Ganglion — Atlo-axial 
Articulation  —  Unequal  Development  —  Caries  —  Dislocation — 
Spontaneous  Reduction — Cervical  Vertebrae — Disproportion 
between  Cause  and  Effect — Example — Unequal  Development  of 
Spinous  Processes  of  Cervical  Vertebrae — Palpation  of  Dorsal 
Spinous  Processes — Normal  Dorsal  Movements — False  Lesions 
— Lateral  Subluxation — Muscular  Contraction — Comparison  of 
Effects  of  Muscular  Contraction — Separation  of  Spinous  Pro- 
cesses— Approximation  of  Spinous  Processes — Primary  Sub- 
luxations — Secondary  Subluxations — Limited  Area  for  Lateral 
Subluxations — Lower  Dorsal  Vertebrae — Dorso-lumbar  Articu- 
lation— Kyphosis,  Lower  Dorsal — Lumbar  Region — Examina- 
tion of  the  Ribs — Costo-central  Articulations — Costo-transverse 
Articulations — Co-ordination — Inco-ordination — Nervous  Con- 
trol of  Respiration — Costal  Subluxations — First  Rib — Tenth  Rib 
— Eleventh  and  Twelfth  Ribs — Effect  of  Position  of  Vertebrae 
on  Position  of  Ribs — The  Clavicles — Summary. 

CHAPTER  XV— The  Diagnostic  Value  of  Backache  311 

Elasticity — A  Field  for  Study — Objective  and  Subjective  Symp- 
toms— Pain — Poise — Structural  Defects — Statics — General  De- 
bility— Sacro-iliac  Subluxation — Spinal  Rotation — Spinal  Cur- 


14  TABLE  OF  CONTENTS 

vat ure — Caries — Rigidity — Arthropathies — Spondylitis  Deform- 
ans — Rachitis — Malignant  Growths — Typhoid  Spine — Lumbago 

—  Posture- — Toxemia — Trauma — Crick  in  the  Back — Involvement 
of  the  Spinal  Cord — Infectious  Fevers — Referred  Visceral  Pains 

—  Inflammation  of  Serous  Membranes — Colicy   Pain — Summary 

—  Plurisegmental  Control  of  Viscera — Reflex  Subluxations — In- 
tensity of  Reaction— Location  of  Reflexes — Reflex  Patterns. 

CHAPTER  XVI— Adaptation  and  Compensation  332 

Definition — The  Spinal  Column — Compensatory  Curvature — 
The  Thorax — The  Heart — Skin  and  Kidneys — Power  of  En- 
cysting— The  Extremities — Law — The  Attitude  of  Rest. 

CHAPTER  XVII— Inhibition  354 

Acceleration,  Inhibition — Muscular  Contraction — Secretion — 
Acceleration  and  Inhibition  as  Attributes  of  Nerve  Tissue — In- 
hibition a  Normal  Attribute  of  the  Central  Nervous  System — 
History — Arrest  of  Activity — Shock — Fatigue — Location  of  In- 
hibition— Muscular  Activity — Three  Characteristics  of  the  Nerv- 
ous System — Development  of  Inhibition — Neurotic  Diathesis, 
Chorea — Paralysis  Agitans — Developing  Inhibition  by  Training 

—  Inhibitory      Effect      of      Pressure — Dosage — Impairment      of 
Function — Physiological  Activity  is  the  Result  of  Stimulation — 
Hilton's  Law — Inhibition,  Therapeutic — How  Vaso-motor  Cen- 
ters  Act — Over-stimulation    Equals    Inhibition — The   Guide   for 
the    Use   of    Inhibition — Pathological    Changes    Which    Accom- 
pany    Over- stimulation — Rational     Treatment — Hyperaesthesia 
of     Sensory     Areas,     Diagnosis — Results     of     Inhibition — The 
Phrase     "Remove     Lesions" — The     Human     Body     is     a     Vital 
Mechanism — Osteopathic  Meaning  of  Inhibition — The  Scientific 
Use   of   Inhibition — Inhibition   as   a    Local   Anaesthetic — Inhibi- 
tion  to    Remove    Lesions — Inhibition   as   a    Preparatory   Treat- 
ment. 

CHAPTER  XVIII— Sounds  Produced  in  Joints  371 

Normal  Sounds — Abnormal  Sounds — Pathology  of  Joints  Pro- 
ducing Abnormal  Sounds — Synovial  Adhesions — Non-use  of  a 
Slightly  Sprained  Joint — Rheumatic  Joints — Semilunar  Carti- 
lages of  the  Knee — Bone  Setting — Historical  Reference — Tar- 
sal  and  Carpal  Subluxations — Enarthrodial  and  Arthrodial 
Joints — Slow  vs.  Quick  Reduction  of  a  Subluxation— Bone- 
Setter's  Phrases — Differences  of  Opinion — "Affections  of  the 
Spine,"  Dr.  Hood — "Crick  in  the  Back" — Manipulation  of  the 
Neck — Manipulation  of  the  Back — Treatment  of.  Upper  Dorsal 
— Comment — Differential  Diagnosis — Size  of  the  Vertebral 
Canal — Conservative  vs.  Radical  Treatment. 

CHAPTER  XIX— Position  for  Examination  384 

Observation — Testing  Alignment  and  Flexibility — Sense  of 
Touch— Inspection— Palpation  of  the  Ribs— Palpation  of  the 
Spine— Extrinsic  and  Intrinsic  Muscles  of  the  Back— Test 
Muscular  Tension — Thoracic  Flexibility — Examination  of  the 
Abdomen — Elevation  or  Depression  of  the  Ribs— Examination 


TABLE  OF  CONTENTS  15 

of  the  Rectum  and  Prostate  Gland — Examination  of  the  Neck — 
The  History  of  Lesions — The  Extremities — Subjective  Symp- 
toms. 

CHAPTER  XX— Manipulation  402 

Methods  of  Procedure — Relaxation  of  the  Latissimus  Dorsi — 
Relaxation  of  the  Trapezius — Relaxation  of  the  Rhomboids — 
The  Pectoralis  Major  and  Serratus  Magnus — Quadratus  Lum- 
borum — Erector  Spinae — Treatment  of  Simple  Kyphosis — Lor- 
dosis,  Upper  Dorsal — The  Possible  Variety  of  Movements 
which  Will  Secure  the  Same  Results — The  Head  and  Neck  as  a 
Lever — Lordosis  or  Kyphosis  May  Affect  a  Function  Similarly 
— Splenius  Capitis  et  Colli — Kyphosis,  Upper  Dorsal — Kypho- 
sis, Dorso-lumbar — Other  Movements — New  Schools — Various 
Applications  of  a  Principle — The  Use  of  a  Fulcrum — Co-ordi- 
nation of  Corrective  Movements— Dorsal  Rotation — Lateral 
Curvature — Know  How  to  Apply  Principles — Do  Not  Copy 
Movements. 

CHAPTER  XXI— Reduction  of  Subluxations  443 

Lateral  Subluxations — Luxations  of  the  Innominate  Bones — 
Anterior  Rotation  of  the  Ilium — Posterior  Rotation  of  the 
Ilium. 

CHAPTER  XXII— Treatment  of  the  Cervical  Region  471 

To  Raise  the  Clavicle — Subluxation  of  the  Clavicle — Preparatory 
Treatment  of  the  Neck,  Trapezius — Sterno-cleido-mastoid — 
Scaleni — Splenius  Capitis  et  Colli — Extension — Rotation — The 
Hyoid  Bone— Mylo-hyoid  and  Hyoglossus — Sterno-thyroid  and 
Sterno-hyoid — Intrinsic  Muscles  of  the  Larynx — The  Atlas — 
Sixth  Cervical — General  Principle  Underlying  Corrective  Move- 
ments— The  Simplest  Form  of  Correction — Torsion  and  Coun- 
ter Pressure — Rigidity — The  Favorable  Position  for  Corrective 
Movements. 

CHAPTER  XXIII— Extremities  493 

Diagnosis — Causes  of  Stiff  Joints — Ankylosis — The  Scapulo- 
humeral  Articulation — Examination  of  the  Brachial  Plexus — 
Reduction  of  Dislocations  by  Traction — Reduction  of  Disloca- 
tions by  Leverage — Elbow  Dislocations — The  Radius — Old  Dis- 
locations— Muscles  of  the  Lower  Extremity — Quadriceps  Ex- 
tensor— The  Adductor  Group — Dislocation  of  the  Femur — 
Stretching  the  Sciatic  Nerve — The  Calf  Muscles — Scientific 
Manipulation — Saphenous  Opening — Semilunar  Cartilages  of 
the  Knee — Paralysis  of  External  Popliteal  Nerve — "Glucokinesis 
and  Mobilisation" — Pain  in  the  Legs  and  Feet — Varicose  Veins. 

CHAPTER  XXIV — Manipulation  for  Vaso-motor  Nerve  Effects  522 
The  Fifth  Cranial  Nerve — Inhibition  of  Suboccipital. 


INTRODUCTION. 

Great  strides  have  been  made  during  the  past  twenty- 
five  years  in  the  practice  of  medicine.  The  relative  posi- 
tions formerly  held  by  drug  therapy  and  surgery  have 
been  completely  reversed.  The  concoctions  of  the  pharmo- 
copoeia,  with  their  vague  and  uncertain  effects  upon  human 
tissues  and  functions,  no  longer  entice  the  earnest  seeker 
after  medical  truths  to  spend  a  lifetime  experimenting 
with  substances  which  are  absolutely  foreign  to  the  human 
body. 

There  was  a  time,  not  far  away,  when  that  person 
who  treated  human  diseases  by  manipulation,  water,  diet 
and  general  hygiene  was  considered  to  be  the  chief  of 
impostors.  Go  a  little  farther  back  in  the  history  of  medi- 
cine and  we  see  surgery  dishonored  because  it  was  me- 
chanical, not  mystical  enough  for  the  ponderous  minds 
whose  fort  it  was  to  deal  with  strange  substances  of  the 
animal,  vegetable  and  mineral  kingdoms. 

During  all  the  years  in  which  drug-therapy  flourished 
there  were  a  few  real  scientists  who  devoted  time  and 
talents  to  the  structure  of  our  bodies  and  the  function  of 
each  part.  Discoveries  came  slowly  along  these  lines  be- 
cause the  majority  of  medical  men  were  concentrating 
their  energies  on  ferreting  out  the  effects  of  drugs.  Facts 
in  anatomy  and  physiology  which  are  so  patent  to  us  at 
this  time  remained  obscure  for  centuries,  simply  because 
there  was  no  thought  of  studying  the  form  and  action  of 
tissues,  while  all  nature  outside  of  our  own  bodies  seemed 
to  be  a  grand  laboratory  of  specifics  for  human  ailments. 

If  osteopathy  had  been  born  fifty  years  ago,  it  would 
have  died  because  the  popular  and  scientific  minds  were 
not  in  a  condition  to, receive  it.  Even  the  time  at  which 


18  INTRODUCTION 

it  was  horn,  scarcely  thirty-five  years  ago,  was  hardly  ripe 
for  this  new  departure  in  medicine.  Twenty  years  easily 
cover  the  period  of  its  active  history. 

A  Scientific  Growth. — There  is  one  distinctive  point 
about  osteopathy  which  should  be  especially  emphasized: 
It  is  not  an  empirical  system;  nothing  is  done  on  the  cut 
and  dry  plan.  It  has  been  developed  in  a  purely  scien- 
tific way.  \Ye  might  observe  the  action  of  the  human 
body  in  health  and  disease  indefinitely  without  securing 
any  exact  data  to  pass  on  to  the  next  generation  of  ob- 
servers if  we  fail  to  know  the  structure  of  the  body.  A 
physician  may  learn  manv  things  in  an  empirical  way 
which  are  very  poor  assets  for  science. 

The  strange  part  of  medical  history,  to  the  modern 
investigator,  is  the  fact  that  discoveries  in  anatomy  and 
physiology,  which  are  of  such  vital  importance  to  the  suc- 
cessful treatment  of  human  diseases,  were  left  stored  away 
between  the  covers  of  books,  not  deemed  of  any  value 
except  to  whet  the  mind  of  the  dilletante  in  medicine. 

Osteopathy  as  a  distinct  system  of  medicine  has 
grown  to  its  present  proportions  at  a  time  when  the  older 
schools  of  medicine  are  making  radical  changes  in  their 
therapeutical  procedures,  e.  g.,  serum-therapy.  In  spite 
of  all  these  so-called  scientific  advances  in  drug-therapy, 
osteopathy  has  made  steady  advance  into  public  favor, 
thereby  showing  that  it  is  fully  able  to  compete  with  the 
older  systems  of  practice. 

The  Founder  of  Osteopathy.— Dr.  A.  T.  Still,  of  Kirks- 
ville.  Mo.,  is  the  honored  founder  of  this  system  of  thera- 
peutics. His  work  was  in  studying  the  structure  of  our 
bodies  directly,  and  thus  gaining  an  accurate  knowledge  of 
how  bones,  ligaments  and  muscles,  blood-vessels,  glands 
and  nerves  are  placed.  Then  he  sought  that  department 
of  knowledge  which  we  call  physiology,  and  learned  how 
these  tissues  act  in  health.  Having  had  previous  train- 
ing in  treating  diseases  by  the  drug  method,  he  was  slow 
to  discard  the  old  method  for  one  which  had  never  been 


INTRODUCTION  19 

tried,  even  though  it  had  good  scientific  reasons  back  of 
it.  But  the  substitution  did  take  place  by  degrees  until  his 
system  of  therapeutics  no  longer  depended  on  the  use  of 
drugs. 

It  seems  to  be  a  popular  idea  that  it  is  necessary  for 
the  founder  of  a  system  to  have  a  creed  or  statement  of 
belief.  We  do  not  doubt  but  that  it  is  good  for  us  at  times 
to  try  to  put  our  beliefs  in  writing,  not  to  form  a  fixed 
position,  but  just  as  the  architect  draws  many  plans  to 
gradually  develop  his  mental  pictures.  These  statements 
usually  contain  the  truth  about  our  work  so  far  as  we 
know  it.  We  can  thus  see  how  far  we  have  advanced 
and  realize  that  we  have  much  to  learn. 

Dr.  Still  has,  from  time  to  time,  expressed  the  result 
of  his  studies,  that  is,  the  observed  facts  upon  which  he 
has  built  his  system  of  therapeutics.  In  1874,  Dr.  Still 
stated  his  observations  as  follows :  "A  disturbed  artery 
marks  the  period  to  an  hour,  and  minute,  when  disease 
begins  to  sow  its  seeds  of  destruction  in  the  human  body. 
That  in  no  case  could  it  be  done  without  a  broken  or  sus- 
pended current  of  arterial  blood  which,  by  nature,  is  in- 
tended to  supply  and  nourish  all  nerves,  ligaments,  mus- 
cles, skin,  bones  and  the  'artery  itself.  The 
rule  of  the  artery  must  be  absolute,  universal,  and  unob- 
structed, or  disease  will  be  the  result.  *  *  All 
nerves  depend  wholly  upon  the  arterial  system  for  their 
qualities,  such  as  sensation,  nutrition  and  motion,  even 
though  by  the  law  of  reciprocity  they  furnish  force,  nu- 
trition and  sensation  to  the  artery  itself." 

Definitions. — Many  definitions  have  been  formulated 
and  published  to  the  world.  Each  one  tends  to  limit 
one's  conception  of  osteopathy  in  some  particular.  A 
definition  always  limits  the  thing  defined,  therefore,  no 
definition  of  osteopathy  can  be  complete,  because  we  are 
dealing  with  a  principle,  the  universality  of  which  no  one 
knows.  Whereas,  less  than  seven  years  ago,  it  was  thought 
that  osteopathy  was  an  excellent  method  of  treating 


20  INTRODUCTION 

chronic  ailments,  we  now  find  osteopaths  working  day 
and  night  at  the  bedside  of  the  acutely  sick.  Thus  does  it 
spread  and  become  thoroughly  recognized  as  a  system 
applicable  to  all  diseases. 

In  order  to  bring  before  the  student  as  full  and  com- 
prehensive an  idea  of  the  scope  of  osteopathy  as  possible, 
a  series  of  definitions  are  quoted.  These  definitions  h  ive 
been  taken  from  current  osteopathic  literature  and  are 
credited  to  their  respective  authors. 

One  of  the  short  paragraphs  in  Dr.  Still's  auto- 
biography is  sufficient  to  give  a  clear  understanding  of  his 
idea  of  the  human  body.  "The  human  body  is  a  machine 
run  by  the  unseen  force  called  life,  and  that  it  may  be  run 
harmoniously,  it  is  necessary  that  there  be  liberty  of  blood, 
nerves  and  arteries  from  the  generating  point  to  des- 
tination." 

The  following  definition  is  one  which  has  been  used 
in  the  American  School  publications  for  a  long  time:  "Os- 
teopathy is  that  science  which  consists  of  such  exact,  ex- 
haustive and  verifiable  knowledge  of  the  structures  and 
functions  of  the  human  mechanism,  anatomical,  physio- 
logical and  psychological,  including  the  chemistry  and 
physics  of  its  known  elements  *as  has  made  discoverable 
certain  organic  laws  and  remedial  resources,  within  the 
body  itself,  by  which  nature,  under  the  scientific  treatment 
peculiar  to  osteopathic  practice,  apart  from  all  ordinary 
methods  of  extraneous,  artificial,  or  medicinal  stimulation, 
and  in  harmonious  accord  with  its  own  mechanical  prin- 
ciples, molecular  activities,  and  metabolic  processes,  may 
recover  from  displacements,  disorganizations,  derange- 
ments, and  consequent  disease,  and  regain  its  normal  equi- 
librium of  form  and  function  in  health  and  sirength." 
Mason  W.  Pressly,  A.  P>..  Ph.  D..  D.  O. 

"Osteopathy  is  that  science  of  healing  which  empha- 
sizes, (a)  the  diagnosis  of  disease  by  physical  methods 
with  a  view  to  discovering  not  the  symptoms  but  the  causes 
of  diseases,  in  connection  with  misplacements  of  tissue, 


INTRODUCTION  21 

obstruction  of  the  fluids  and  interference  with  the  forces 
of  the  organism ;  (b)  the  treatment  of  diseases  by  scientific 
manipulations  in  connection  with  which  the  operating 
physician  mechanically  uses  and  applies  the  inherent  re- 
sources of  the  organism  to  overcome  disease  and  establish 
health,  either  by  removing  or  correcting  mechanical  dis- 
orders, and  thus  permitting  nature  to  recuperate  the  dis- 
eased part,  or  by  producing  and  establishing  antitoxic  and 
antiseptic  conditions  to  counteract  toxic  and  septic  con- 
ditions of  the  organism  or  its  parts;  (c)  the  application 
of  mechanical  and  operative  surgery  in  setting  fractured 
or  dislocated  bones,  repairing  "lacerations  and  removing 
abnormal  tissue  growths  or  tissue  elements  when  these 
become  dangerous  to  the  organic  life."  J.  Martin  Little- 
John,  LL.  D.,  M.  D.,  D.  O. 

"Osteopathy  is  a  school  of  mechanical  therapeutics 
based  on  several  theories.  1.  Anatomical  order  of  the 
bones  and  other  structures  of  the  body  is  productive  of 
physiological  order,  i.  e.,  ease  or  health  in  contradistinc- 
tion to  disease  or  disorder  which  is  usually  due,  directly 
or  indirectly,  to  anatomical  disorder.  2.  Sluggish  organs 
may  be  stimulated  mechanically  by  way  of  appropriate 
nerves  (frequently  by  utilizing  reflexes)  or  nerve  centers. 
3.  Inhibition  of  over-active  organs  may  be  effected  by 
steady  pressure  substituted  for  the  mechanical  stimulation 
mentioned  above.  4.  Removal  of  causes  of  faulty  action 
of  any  part  or  organ  is  the  keynote  of  the  science."  C.  M. 
Case,  M.  D.,  D.  O. 

"Osteopathy  is  that  school  of  medicine  whose  dis- 
tinctive method  consists  in  (1)  a  physical  examination  to 
determine  the  condition  of  the  mechanism  and  functions 
of  all  parts  of  the  human  body,  and  (2)  a  specific  manipu- 
lation to  restore  the  normal  mechanism  and  re-establish 
the  normal  functions.  This  definition  lays  stress  (1)  upon 
correct  diagnosis.  The  osteopath  must  know  the  normal 
and  recognize  any  departure  from  it  as  a  possible  factor 
in  disease.  There  is  not  one  fact  known  to  the  anatomist 


22  INTRODUCTION 

or  physiologist  that  may  not  be  of  vital  importance  to 
the  scientific  osteopath.  Hence  a  correct  diagnosis  based 
upon  such  knowledge  is  half  the  battle.  Without  it  scien- 
tific osteopathy  is  impossible  and  the  practice  is  neces- 
sarily haphazard  or  merely  routine  movements.  The  defi- 
nition lays  stress  upon  (2)  removal  of  the  cause  of  disease. 
A  deranged  mechanism  must  be  corrected  by  mechanical 
means  specifically  applied  as  the  most  natural  and  only 
direct  method  of  procedure.  This  work  is  not  done  by 
any  of  the  methods  of  other  schools.  After  the  mechanism 
has  been  corrected  little  remains  to  be  done  to  restore 
function,  but  stimulation  or  inhibition  of  certain  nerve 
centers  may  give  temporary  relief  and  aid  nature.  The 
adjuvants  used  by  other  schools,  such  as  water,  diet,  exer- 
cise, surgery,  etc.,  are  the  common  heritage  of  our  profes- 
sion and  should  be  resorted  to  by  the  osteopath  if  they  are 
indicated."  E.  R.  Booth,  Ph.  D.,  D.  O.,  Ex-President 
A.  O.  A. 

"Osteopathy  is  that  science  or  system  of  healing  which, 
using  every  means  of  diagnosis,  with  a  view  to  discover- 
ing, not  only  the  symptoms,  but  the  causes  of  diseases, 
seeks,  by  scientific  manipulations  of  the  human  body,  and 
other  physical  means,  the  correcting  and  removing  of  all 
abnormalities  in  the  physical  relations  of  the  cells,  tissues 
and  organs  of  the  body,  particularly  the  correcting  of  mis- 
placements of  organs  or  parts,  the  relaxing  of  contracted 
tissues,  the  removing  of  obstructions  to  the  movements 
of  fluids,  the  removing  of  interferences  with  the  trans- 
mission of  nerve  impulses,  the  neutralizing'  and  removing 
of  septic  or  foreign  substances  from  the  body;  thereby  re- 
storing normal  physiological  processes,  through  the  re- 
establishment  of  normal  chemical  and  vital  relations  of 
the  cells,  tissues  and  organs  of  the  body,  and  resulting  in 
restoration  of  health,  through  the  automatic  stimulation 
and  free  operation  of  the  inherent  resistant  and  remedial 
forces  within  the  body  itself."  C.  M.  Turner  TTulett,  D.  O. 


INTRODUCTION  23 

"Osteopathy  is  that  science  which  reasons  on  the 
human  system  from  a  mechanical  as  well  as  a  chemical 
standpoint,  taking  into  consideration  in  its  diagnosis, 
heredity,  the  habits  of  the  patient,  past  and  present;  the 
history  of  the  trouble,  including  symptoms,  falls,  strains, 
injuries,  toxic  and  septic  conditions,  and  especially  in  every 
case  a  physical  examination  by  inspection,  palpation,  per- 
cussion, ausculation,  etc.,  to  determine  all  abnormal  physi- 
cal conditions ;  the  treatment  emphasizing  scientific  manip- 
ulation to  correct  mechanical  lesions,  to  stimulate  or  in- 
hibit and  regulate  nerve  force  and  circulatory  fluids  for 
the  recuperation  of  any  diseased  part,  using  the  vital  forces 
within  the  body;  also  the  habits  of  the  patient  are  regu- 
lated as  to  hygiene,  air,  food,  water,  rest,  exercises,  climate 
and  baths ;  such  means  as  hydropathy,  electricity,  massage, 
antidotes  and  antiseptics,  and  suggestion  sometimes  being 
used  as  adjuncts."  Chas.  C.  Reid,  D.  O. 

The  above  definitions  have  nearly  all  been  taken  from 
the  Journal  of  the  American  Osteopathic  Association. 

Osteopathic  Diagnosis. — Physical  diagnosis  is  and  al- 
ways will  be  the  leading  factor  in  the  success  of  osteo- 
pathic  practitioners.  This  ability  to  take  hold  of  an  ailing 
human  being  and  detect  the  disturbing  factor  in  it  is  the 
highest  attainment  of  the  physician.  Osteopathy  has  de- 
veloped the  art  of  palpation  to  a  wonderful  degree.  Bas- 
ing this  art  on  a  definite  knowledge  of  structure  and 
function  makes  it  the  chief  reliance  in  diagnosis.  Every 
physical  diagnosis  begins  with  palpation  and  proceeds  with 
ausculation  and  percussion,  and  not  failing  to  use  chemical 
and  microscopical  methods  when  necessary.  The  student 
must  learn  to  use  his  sense  of  touch  continually,  in  fact, 
learn  to  see  with  his  fingers.  Add  to  this  development  of 
touch  a  training  in  chemical  and  microscopical  analysis  of 
secretions  and  excretions  of  the  body,  and  we  have  a 
practitioner  thoroughly  equipped  to  make  an  accurate 
scientific  diagnosis. 


24  INTRODUCTION 

Osteopathic  Therapeutics. — Osteopathic  treatment  is 
based  on  this  kind  of  physical  diagnosis  which  \ve  have 
just  described.  It  takes  into  account  the  fact  that  the 
organism  is  a  self-recuperating  mechanism  and  requires 
proper  food,  proper  surroundings,  and  perfect  activity  of 
every  tissue,  especially  the  blood.  Thus  we  divide  treat- 
ment into  three  divisions.  (1)  manipulation  for  the  pur- 
pose of  correcting  the  mal-position  of  any  tissue,  whether 
that  tissue  be  bone  or  blood ;  (2)  proper  feeding,  i.  e.. 
dietetics;  and  (3)  proper  surroundings,  i.  e.,  hygiene. 

If  the  condition  of  the  body  is  such  that  none  of  the 
three  methods  just  mentioned  will  right  the  difficulty,  i.  e., 
if  there  are  broken  bones,  ruptured  muscles  and  connec- 
tive tissues  or  false  growths,  we  can  then  use  surgical 
means.  Surgery  is  a  part  of  the  Osteopathic  system,  just 
as  it  is  of  all  systems  of  medicine.  The  chief  assurance 
lies  in  the  fact  that  the  Osteopathic  system  is  very  con- 
servative as  regards  the  use  of  the  knife. 

Osteopathy  includes  all  those  qualities  which  make 
up  a  successful  system ;  its  diagnosis  is  accurate  and  its 
treatment  is  comprehensive,  including  scientific  manipula- 
tions, scientific  dietetics,  hygiene  and  surgery. 

In  a  recent  article  in  the  American  Monthly  Review 
oi  Reviews,  the  following  sentences  appear :  "\Yith  but 
few  exceptions,  the  entire  vegetable  and  mineral  kingdoms 
have  given  us  little  of  specific  value;  but  still,  up  to  the 
present  day,  the  bulk  of  our  books  on  materia  medica  is 
made  up  of  a  description  of  many  valueless  drugs  and 
preparations.  Is  it  not  to  be  deplored  that  valuable  time 
should  be  wasted  in  our  student  days  by  cramming  into 
our  heads  a  lot  of  therapeutic  ballast." 

This  is  probably  the  most  recent  statement  of  this 
kind  in  the  public  prints.  It  substantiates  the  position 
taken  by  the  osteopathic  colleges.  \Yc  feel  justified  in 
claiming  that  osteopathy  today  occupies  a  position  which 
every  other  system  of  medicine  must  come  to  sooner  or 
later.  It  is  broad  enough  and  liberal  enough  to  accept 


INTRODUCTION  25 

truth  wherever  demonstrated.  Its  foundations  being  laid 
in  the  basic  sciences,  and  its  treatment  never  departing 
from  the  facts  of  these  sciences,  make  it  a  system  of  lasting 
worth  and  capable  of  adding  an  entirely  new  conception 
of  the  phenomena  of  life  to  medical  literature. 

The  formation  of  the  name  osteopathy  (from  osteon, 
bone,  and  pathos,  suffering)  seems  to  be  as  perfect  a  de- 
scriptive name  as  it  is  possible  to  form  which  would  cover 
the  basic  principle  of  the  science.  The  bones  are  the 
foundation  upon  which  all  the  soft  tissues  are  laid,  and 
the  osteopath  makes  all  his  examinations,  using  them  as 
fixed  points  from  which  to  explore  for  faulty  arrange- 
ment. The  name  does  not  mean  bone  disease,  but  since 
the  osteopath  finds  many  diseases  resulting  from  irritation 
due  to  slightly  displaced  bone,  the  name  is  used  in  the 
sense  of  disease  caused  by  bone.  We  do  not  consider  that 
all  diseases  are  caused  by  displaced  bone,  but  it  is  a  cause 
which  has  heretofore  been  overlooked.  We  recognize  that 
there  are  many  causes  of  disease,  and  do  not  wish  to  be 
understood  as  trying  to  fit  fact  to  theory,  but  as  a  result 
of  observing  certain  facts,  this  basic  principle  of  osteo- 
pathy has  been  made  clear. 

We  believe  that  health  is  the  natural  state,  and  that 
this  condition  is  bound  to  be  maintained  so  long  as  every 
cell  has  an  uninterrupted  blood  supply,  and  its  controlling 
nerve  is  undisturbed.  Therefore,  the  first  effort  of  the 
osteopath  is  to  remove  all  obstructions  to  blood  and  nerve 
supply,  feeling  certain  that  when  these  obstructions  are 
removed,  health  will  follow.  Hilton  in  his  lectures  on 
"Rest  and  Pain,"  which  are  considered  medical  classics, 
has  expressed  himself  forcibly  on  this  subject,  as  follows: 
"It  would  be  well,  I  think,  if  the  surgeon  would  fix  upon 
his  memory,  as  the  first  professional  thought  which  should 
accompany  him  in  the  course  of  his  daily  occupation,  this 
physiological  truth — that  nature  has  a  constant  tendency 
to  repair  the  injuries  to  which  her  structures  may  have 
been  subjected,  whether  those  injuries  be  the  result  of 


26  INTRODUCTION 

fatigue  or  exhaustion,  of  inflammation  or  accident.  Also, 
that  this  reparative  power  becomes  at  once  most  con- 
spicuous when  the  disturbing  cause  has  been  removed; 
thus  presenting  to  the  consideration  of  the  physician  and 
surgeon  a  constantly  recurring  and  sound  principle  for  his 
guidance  in  his  professional  practice." 

Every  system  of  curing  human  ills  which  is  based  on 
the  known  facts  of  anatomy  and  physiology  will  last, 
because  it  is  true.  When  systems  of  drug  medication  are 
known  only  as  history,  osteopathy  will  be  ministering  to 
the  human  race,  because  it  knows  no  other  path  than  that 
which  leads  to  greater  truths  in  physiology  and  anatomy. 


PRINCIPLES  OF  OSTEOPATHY  27 


CHAPTER  I. 

CAUSES  OF  DISEASE. 

Normal  and  Abnormal. — In  order  to  use  the  word  ab- 
normal, with  reference  to  the  structure  and  function  of  living 
tissues,  we  must  have  knowledge  of  the  normal.  Normal  is 
a  word  having,  apparently,  as  many  interpretations  as  the 
word  "beauty,"  i.  e.  standards  to  which  these  words  are 
applied  differ,  even  as  the  individuals  who  use  them.  In 
order  that  we  make  clear  what  we  conceive  as  normal  and 
abnormal  conditions,  it  is  necessary  to  call  attention  to 
variations  in  structure  and  function,  which  should  be  recog- 
nized as  not  being  far  enough  removed  from  typical  condi- 
tions to  indicate  the  existence  of  a  need  for  corrective 
interference. 

The  Ideal  Normal. — Our  first  steps  in  the  acquirement 
of  a  medical  education  are  practically  all  concerned  with 
study  of  the  normal.  We  dissect  bodies  which  have  been 
changed  by  disease  and  therefore  we  come  in  contact  with 
abnormality.  To  counteract  this  we  study  descriptive  anat- 
omy and  idealize  our  real  knowledge  which  was  obtained  by 
dissection.  Ofttimes  our  ideal  has  such  attributes  of  perfec- 
tion that  nothing  ever  comes  up  to  standard  and  hence  ap- 
pears to  us  to  be  defective.  This  hypercritical  attitude  leads 
to  exaggeration  of  the  interpretation  put  upon  symptoms 
and  hence  leads  to  misdirected  efforts  at  correction. 

Variations  in  Structure  and  Function. — We  need  there- 
fore, first  of  all,  a  fairly  good  knowledge  of  the  variations  in 
structure  and  function  which  may  be  recognized  as  consid- 
erable departures  from  type,  but  still  not  abnormal  in  the 
sense  we  use  that  term  when  speaking  of  disease.  No  tissue 


28  PRINCIPLES  OF  OSTEOPATHY 

in  the  body  is  unyielding  and  hence  will  adapt  itself  to  even 
a  very  moderate  force,  if  that  force  is  long  continued.  This 
is  well  illustrated  by  the  great  changes  which  can  be  pro- 
duced in  the  alignment  of  the  teeth  under  corrective  bracing. 

Adaptation. — The  changes  in  structure,  which  are  fre- 
quently recognized,  may  be  evidence  of  adaptation,  i.  e.  they 
are  the  final  result  of  the  body's  effort  to  maintain  its  exis- 
tence at  the  highest  point  of  efficiency  of  which  it  is  capable. 
With  this  thought  ever  in  our  minds  we  may  safely  observe 
the  character  of  structures  and  draw  more  just  conclusions 
as  to  the  existence  of  normal  or  abnormal  conditions. 

Normal  Health. — People  usually  seek  the  services  of  a 
physician  because  they  suffer  some  degree  of  discomfort. 
True  it  is  that  some  seek  a  cosmetic  effect,  but  this  may 
hardly  be  seriously  considered.  Normal  health  means  a  con- 
dition wherein  we  are  unconscious  of  bodily  distress  and  are 
able  to  do  what  is  ordinarily  counted  as  our  share  of  work. 
This  state  of  bodily  comfort,  under  the  ordinary  stress  of 
labor,  is  not  necessarily  based  upon  symmetry  of  structural 
development,  i.  e.  absolute  conformity  to  our  ideal  of  struc- 
tural perfection. 

Comfort  and  Efficiency. — Normality  from  the  cradle  to 
the  grave  seems  to  be  a  personal  equation,  i.  e.  bodily  com- 
fort under  the  stress  of  moderate  physical  and  mental  exer- 
tion. Increase  of  physical  or  mental  exertion  either,  through 
adaptation,  produces  increased  capacity,  or,  through  failure 
of  adaptation,  produces  destructive  changes.  Comfort  and 
efficiency  are  the  real  attributes  of  normality.  If  these  are 
present  in  average  degree  there  is  little  likelihood  of  a  physi- 
cian being  consulted. 

Variation  of  the  Normal. — The  normal  of  any  individual 
varies  at  different  periods  of  life  and  following  accidents  or 
severe  illnesses.  The  physician  is  frequently  consulted  with 
the  hope  that  the  normal  of  later  years  might  be  raised  to 
the  degree  consciously  possessed  at  a  former  time,  or  in  the 
hope  of  being  restored  to  the  normal  which  existed  previous 
to  an  accident  or  severe  illness.  The  new  normals  which 


PRINCIPLES  OF  OSTEOPATHY  29 

constitute  the  result  of  repair  after  injury  and  illness  do  not 
measure  up  to  the  previous  standard  in  most  cases.  Con- 
sciousness of  a  decrease  in  efficiency  leads  many  people  to 
the  hope  of  securing  an  increase  by  some  specific  means. 

Distress  and  Inefficiency. — The  physician  is  constantly 
dealing  with  two  classes  of  patients,  those  who  suffer  bodily 
distress,  and  those  who  are  conscious  of  bodily  inefficiency, 
in  some  degree,  and  hence  suffer  mental  distress.  It  is  allur- 
ing to  sufferers  of  either  class  to  think  there  is  a  specific  re- 
movable cause  of  their  distresses,  hence  any  form  of  treat- 
ment, aiming  to  specifically  attack  the  cause,  has  a  captivat- 
ing character. 

Difference  in  Belief  as  to  Causes. — All  forms  of  treat- 
ment are,  at  least  in  fancy,  based  on  the  desire  to  remove 
the  cause  of  the  ailment.  The  reason  there  is  such  wide  dis- 
crepancy in  methods  is  because  of  differences  in  belief  as  to 
causes.  In  other  words,  if  all  forms  of  disease  were  thor- 
oughly understood,  i.  e.  as  to  cause  as  well  as  manifestations, 
there  would  very  quickly  develop  an  agreed  form  of  treat- 
ment. It  appears  so,  but  there  is  another  factor  to  consider. 
The  same  disease,  due  to  the  same  cause,  does  not  manifest 
itself  the  same  in  every  individual,  therefore  the  same  means 
used  to  remove  the  cause  does  not  bring  the  same  reaction 
in  every  individual.  This  has  led  to  a  multiplicity  of  meth- 
ods even  where  the  cause  is  known.  It  is  certainly  a  great 
gain  to  have  but  one  unknown  quantity,  the  vitality  of  the 
patient,  instead  of  the  two  that  previously  existed,  i.  e.  the 
cause  of  the  illness  and  the  vitality  of  the  patient.  This  de- 
sire to  have  but  one  unknown  quantity  has  frequently  led  to 
the  development  of  medical  dogmas  based  on  a  belief  in  the 
existence  of  certain  causes  of  disease.  The  germ  theory  and 
the  lesion  theory  are  good  present  day  examples.  Both  the 
germs  and  the  lesions  are  so  universally  found  that  both 
form  convenient  foundations  for  dogmatizing. 

Interpretation  of  Phenomena  of  Disease.— Although 
these  studies  are  directly  concerned  with  the  phenomena  of 
lesions  there  is  no  desire  on  our  part  to  exalt  any  group  of 


30  PRINCIPLES  OF  OSTEOPATHY 

phenomena  out  of  its  comparative  value  with  any  other 
group.  It  is  hoped  that  by  presenting,  as  well  as  we  are  able, 
the  lesion  theory  of  disease,  we  may  be  able  to  show  paths  of 
convergence  leading  to  a  better  interpretation  of  disease 
phenomena  and  thus  the  truths  which  underlie  the  lesion 
theory  will  not  become  distorted  into  fantastic  vagaries. 
We  do  not  wish  to  be  understood  as  claiming  for  osteopathy 
the  discovery  of  the  cause  of  disease.  There  are  many 
causes,  widely  divergent  in  character.  Osteopathy  brings  to 
your  attention  a  cause,  frequently  found  and  of  sufficient 
definiteness  to  warrant  concentrated  attention. 

Favorable  Reaction  to  Environment. — Since  we  are 
mechanisms  of  living  tissues,  our  survival  depends  upon  re- 
acting favorably  to  environment.  We  find  the  elements,  air, 
light,  heat  and  cold  all  affect  us  adversely  at  times.  They 
become  destroyers  of  bodily  comfort  and  efficiency  when 
intensified.  Changes  in  atmospheric  pressure,  intensifica- 
tion of  light,  increased  heat  or  cold,  affect  us  seriously. 

Known  Causes  of  Disease. — Chemical  poisons,  such  as 
lead,  arsenic,  mercury,  phosphorus,  carbon  monoxide  and 
other  gases,  are  causes  of  profound  injury.  The  organic 
poisons,  alcohol,  opium,  morphine,  cocaine,  food  poisons, 
snake  venoms,  autointoxications,  play  no  small  part  in  caus- 
ing bodily  discomfort  and  inefficiency.  The  vegetable  or- 
ganisms, fungi  and  bacteria  claim  abundant  recognition  as 
causes  of  disease.  Protozoa  are  properly  listed  as  causes, 
for  have  we  not  the  wonderful  discoveries  concerning  ma- 
larial fever,  sleeping  sickness,  amoebic  dysentery  and  yellow 
fever;  sufficient  scientific  achievements  to  startle  the  world. 
The  fluke,  cestode  and  round  worm  infections  have  long 
been  recognized  causes  of  disease.  Add  to  the  foregoing  all 
those  adverse  conditions  imposed  by  the  nature  of  our 
crowded  existence  in  cities,  noise  and  unrest,  surfeit  and 
poverty,  fatigue  and  worry,  it  is  little  to  be  wondered  at  that 
we  find  ourselves  searching  almost  hysterically  for  some 
thing  to  aid  us  to  survive  it  all. 


PRINCIPLES  OF  OSTEOPATHY  31 

The  Tenacity  of  Life. — It  is  marvelous  how  our  bodies 
adapt  themselves  to  all  the  vicissitudes  of  environment,  sur- 
vive the  effects  of  inorganic  and  organic  poisons,  invasions 
of  bacteria  or  protozoa,  maintain  existence  in  spite  of  defi- 
cient food  and  rest.  The  tenacity  of  life  in  human  tissues, 
the  adaptations  and  compensations  that  are  developed,  are 
worthy  the  pen  of  some  scientific  genius  who  has  the  literary 
ability  to  make  the  layman  have  faith  in  natural  law. 

Lesion-Disease  Association. — With  all  these  causes  of 
disease  we  may  well  ask  ourselves  what  relation  the  spinal 
or  other  joint  lesion  has.  It  would  be  difficult  to  find  any 
disease  process  that  does  not  exhibit  a  spinal  or  other^joint 
lesion,  in  the  sense  we  osteopaths  recognize.  This  coin- 
cidence of  disease  and  spinal,  or  other,  joint  lesion  does  not 
necessarily  indicate  a  sequence  of  events  starting  in  the  le- 
sion. As  scientists,  rather  than  special  pleaders  for  a  theory, 
we  want  to  know  the  significance  of  this  association.  It  is 
our  aim  to  devote  the  pages  following  to  an  analysis  of  this 
lesion-disease  association.  We  aim  to  write  helpfully,  ana- 
lyzing our  failures  that  we  may  know  our  weaknesses,  an- 
alyzing our  successes  so  that  we  may  make  our  solid  prin- 
ciples more  widely  recognized. 

Remove  the  Cause  of  Disease. — No  great  amount  of 
analysis  of  the  various  causes  of  disease  is  required  before 
we  realize  that  to  "remove  the  cause"  we  must  do  something 
more  than  treat  individual  members  of  society.  There  is  a 
phase  of  medical  practice  which  requires  us  to  view  the  good 
of  the  community  rather  than  any  portion  of  it.  Some  lives 
are  sacrificed  because  we  have  no  cure  for  the  individual. 
We  cure  the  community,  the  race,  by  sacrificing  the  individ- 
ual. Public  health  requires  what  seems  to  be  cruelty  toward 
the  individual  from  whose  disease  we  must  be  protected. 

Preventive  Medicine. — As  fast  as  causes  of  certain  dis- 
eases have  been  demonstrated,  plans^  for  prevention  take 
precedence  over  treatment  of  the  individuals  who  suffer  from 
those  diseases.  Thus  a  new  class  of  physicians  is  developed, 
i.  e.  those  trained  to  cope  with  the  problems  of  preventive 


32  PRINCIPLES  OF  OSTEOPATHY 

medicine  rather  than  meet  the  exigencies  of  treating  in- 
dividual patients.  It  is  the  necessarily  aggressive  advance 
of  preventive  medicine  which  arouses  antagonism  and  social 
discord.  Xo  one  could  successfully  contend  that  all  preven- 
tive methods,  thus  far  enforced,  are  satisfactory.  Then,  too, 
it  is  not  possible  to  demonstrate  quickly  to  all  the  members 
of  a  community  the  necessity  for  certain  procedures.  Sacri- 
fice of  the  individual,  be  it  ever  so  slight,  for  the  good  of  the 
whole,  is  not  agreeable  to  the  victim  or  his  friends.  Altho 
we  are  developing  methods  primarily  applicable  to  the  in- 
dividual rather  than  serving  the  aggressive  purposes  of  pre- 
ventive medicine,  that  which  makes  the  individual  an  effi- 
cient member  of  society  subserves  public  health. 

Symptoms. — Diseases  manifest  themselves  by  certain 
phenomena  which  are  designated  as  symptoms.  Symptoms 
are  abnormal  degrees  of  normal  reaction.  This  is  made  evi- 
dent by  the  fact  that  some  symptoms  represent  sub-  and 
others  supernormal  functioning.  The  supernormal  function- 
ing represents  a  reaction,  on  the  whole  favorable  to  recovery, 
whereas  the  subnormal  reaction  is  not  favorable.  Since  the 
symptoms  represent  phases  of  reaction  or  non-reaction  in 
tissues,  the  effort  put  forth  by  the  body,  as  a  whole,  to  re- 
cover, is  in  proportion  to  the  energy  contained  in  its  cells. 
In  a  restricted  sense  the  cause  of  disease  is  in  the  cells  of  the 
body.  They  contain  the  stored  energv.  i.  e  .,  po- 
tential energy.  \Yhen  this  potential  energy  is  re- 
leased by  some  force,  or  stimulus,  \ve  have  kinetic  energy. 
Potential  energy  does  not  transfer  itself  spontaneously  into 
kinetic  energy  without  first  being  affected  by  some  other 
force,  which  may  be  called  a  stimulus.  The  amount  of  po- 
tential energy  converted  into  kinetic  is  not  proportional  to 
the  amount  of  the  stimulus  used  to  initiate  the  process.  All 
stored  energy,  i.  e..  potential  energy,  requires  a  certain 
strength  of  stimulus. to  start  the  process  of  conversion  into 
kinetic.  When  this  strength  of  stimulus  is  known,  it  is  called 
the  normal.  There  are  usually  several  kinds  of  stimuli,  each 
one  having  a  varying  degree  of  intensity.  For  example,  the 


PRINCIPLES  OF  OSTEOPATHY  33 

potential  energy  in  a  muscle  fiber  will  be  converted  into  ki- 
netic energy  as  a  result  of  mechanical,  thermal,  chemical  or 
electrical  stimuli.  Certain  amounts  of  each  of  these  stimuli 
are  required  to  initiate  the  change  in  the  form  of  energy. 

A  Normal  Stimulus. — The  potential  energy  in  a  muscle 
fiber  has  a  certain  degree  of  resistance  to  stimuli.  A  definite 
amount  of  any  one  of  the  four  forms  of  stimuli  named  is 
necessary  to  cause  the  muscle  fiber  to  contract.  This  defi- 
nite amount,  which  is  capable  of  stimulating  the  muscle  to 
an  average  contraction,  is  called  the  normal  stimulus,  and 
the  action  of  the  muscle  is  called  the  normal  contraction.  If 
the  muscle  should  contract  more  vigorously  than  usual  in 
response  to  this  normal  stimulus,  the  resistance  of  the  po- 
tential energy  of  the  muscle  fiber  is  below  normal.  The 
strength  of  stimulus  and  discharge  of  energy  may  vary 
greatly  in  their  proportions  within  normal  limits,  but  there 
are  well  marked  lines  above  or  below  which  resistance  is 
spoken  of  as  above  or  below  normal. 

A  Change  of  Resistance. — When  the  resistance  of  the 
potential  energy  is  below  normal,  a  normal  stimulus  causes 
too  great  an  effect,'  that  is,  too  much  potential  energy  is 
transferred  into  kinetic  energy.  When  the  resistance  of  the 
potential  energy  is  normal,  and  the  stimulus  above  normal, 
there  also  results  an  excessive  discharge  of  potential  energy. 
Therefore,  excessive  discharge  results  from  lowered  resis- 
tance, or  increase  of  stimulus.  Resistance  is  a  quality  of  the 
cell  protoplasm.  The  stimulus  is  an  external  force.  The 
cell  depends  on  proper  surroundings  in  order  to  maintain  its 
resistance  to  external  stimuli,  such  as  bacteria.  The  strength 
of  bacteria  may  also  be  increased  or  decreased  by  the  nature 
of  their  surroundings. 

Cause  and  Effect. — After  potential  energy  has  been 
changed  into  kinetic  energy,  this  latter  may  generate  more 
potential  energy,  and  this  also  may  be  converted  into  kinetic. 
Thus  cause  is  converted  into  effect  and  effect  into  cause. 
This  is  an  endless  chain.  When  such  a  process  is  beyond  the 
normal,  as  in  the  body  when  varying  symptoms  present 


34  PRINCIPLES  OF  OSTEOPATHY 

themselves,  therapeutic  efforts  must  be  concentrated  on 
some  particular  reflex  in  order  to  break  the  chain. 

Cell  Relations. — The  relations  of  a  cell  with  its  fellows, 
that  is.  its  structural  relations,  are  the  basis  upon  which  its 
resistance,  in  large  measure,  depends.  Therefore,  anything 
which  disarranges  its  normal  relations  will,  in  all  proba- 
bility, change  its  resistance  to  stimuli.  All  therapeutic 
methods  which  aim  at  lessening  the  too  rapid  conversion  of 
potential  into  kinetic  energy,  that  is,  increasing  cell  resist- 
ance, must  see  that  correct  structure  is  attained. 

Excessive  Stimulation.— In  cases  where  almost  com- 
plete exhaustion  of  potential  energy  has  resulted  from  low- 
ered resistance  and  we  find  that  even  increased  strength  of 
stimulus  fails  to  evoke  a  response,  the  same  structural  fault 
may  exist.  \Ye  know  that  stimulation,  when  excessive, 
passes  into  inhibition.  Perhaps  it  is  truer  to  state  that  over- 
activity  of  a  cell  leads  to  exhaustion  of  its  potential  energy. 
The  stage  of  exhaustion,  in  this  sense,  is  consonant  with  in- 
hibition. As  an  example:  In  case  of  structural  changes  in 
the  lower  dorsal  region,  there  may  result  a  change  in  re- 
sistance in  the  secretory  and  contractile  cells  of  the  intes- 
tines, due  to  changed  blood  supply.  Diarrhoea  results  for  a 
time,  followed  by  constipation.  At  the  beginning  of  the 
rapid  conversion  of  potential  into  kinetic  energy  the  muscles 
feel  tense.  After  the  constipation,  or  period  of  exhaustion, 
sets  in,  they  are  flabby. 

Structural  Defects. — Structural  defects  may  result  in 
lowered  resistance  in  groups  of  cells.  They  also  act  as  stim- 
uli to  set  free  the  potential  energy  in  these  cells.  In  many 
cases  we  note  only  a  predisposition  to  yield  to  weak  stimuli. 
This  is  the  condition  in  individuals  who  are  "fairly  well," 
but  cannot  endure  any  of  the  normal  stimuli  in  average 
amount.  They  cannot  exercise  freely  without  a  bad  reac- 
tion. A  slightly  heavier  meal  than  usual,  the  excitement  due 
to  the  presence  of  many  people,  arouses  "symptoms."  Their 
physiological  processes  are  easily  perverted  by  normal  stim- 
uli because  a  structural  defect,  either  directly  or  indirectly, 


PRINCIPLES  OF  OSTEOPATHY  35 

has  decreased  cell  resistance.  Cases  of  lowered  resistance, 
supposed  to  be  due  to  heredity,  should  be  carefully  exam- 
ined for  structural  defects.  It  is  not  improbable  that  many 
an  ancestor  is  wrongly  accused  of  transmitting  a  "predispo- 
sition." While  cell  resistance  remains  below  normal,  all  ex- 
ternal stimuli,  such  as  atmospheric  changes  and  the  presence 
of  bacteria,  even  if  in  only  normal  amounts,  may  call  forth 
"symptoms  of  disease." 

Cell  Life  Dependent  on  Circulation. — The  individual 
cells  of  the  body  depend  on  the  supply  of  nourishment 
brought  to  them  by  the  circulating  fluids  of  the  body.  The 
protoplasm  of  the  cells  is  a  complex,  chemical  substance 
made  up  of  an  enormous  number  of  complex  molecules. 
These  molecules,  on  account  of  the  looseness  of  combina- 
tion of  their  atoms,  require  sufficient  crude  material  brought 
to  them  to  maintain  the  proper  atomic  tension.  Upon  this 
tension  is  based  the  resistance  to  normal  or  abnormal  stimuli. 
The  necessary  food  for  cell  protoplasm  is  brought  to  the 
cells  by  blood  and  lymph.  Since  cell  protoplasm  is  entirely 
dependent  upon  the  circulating  media,  any  disturbance  of 
these  media  changes  the  metabolism  of  the  cell,  and  hence 
a  change  in  resistance  results.  This  resistance  may  be  varied 
by  failure  on  either  the  arterial  or  venous  side  of  the  general 
circulation,  resulting  in  changed  lymph  circulation.  The 
constant  removal  of  katabolic  products  is  of  as  much  im- 
portance as  the  constant  renewal  of  material  for  anabolism. 

Intracellular  Tension. — Intracellular  tension,  i..  e.,  the 
cohesiveness  of  the  atoms  of  each  molecule,  is  dependent  on 
lymphatic  circulation ;  this  upon  arterial  and  venous  circula- 
tion. If  there  is  abnormal  variation  in  any  of  these  circula- 
tory fluids,  there  results  a  change  in  resistance  of  the  cells. 
Therefore,  a  normal  stimulus  may  provoke  too  great  a  trans- 
ference of  potential  into  kinetic  energy  and  thus  initiate  a 
chain  of  such  transferences  of  one  form  of  energy  into  an- 
other. As  a  rule,  the  kinetic  energy  which  results  from  the 
release  of  potential  energy,  in  excessive  amounts,  acts  as  a 
stimulus  to  release  still  more  potential  energy  and  so  on  to 


36  PRINCIPLES  OF  OSTEOPATHY 

the  point  of  exhaustion  of  the  supply  of  such  stored  energy. 
This  change  is  exemplified  in  the  series  of  symptoms  which 
appear  in  many  diseases.  Each  liberation  of  a  new  supply 
of  energy  gives  rise  to  a  new  system.  If  the  potential  en- 
ergy resides  in  a  gland,  excessive  secretion  results;  if  in  mus- 
cle, excessive  contraction,  etc.  The  way  in  which  the  kinetic 
energy  is  manifested  depends  upon  the  manner  in  which  its 
cause,  i.  e.,  potential  energy,  is  stored.  The  secretion  or  the 
contraction  may  act  as  a  stimulus  to  liberate  still  more  po- 
tential energy. 

Scientific  Therapeutics. — Therapeutic  methods  become 
scientific  just  in  proportion  as  they  are  based  on  the  known 
structure  and  function  of  the  tissues  and  the  exact  cause  of 
the  disturbed  condition  of  the  tissues,  i.  e.,  the  disease.  The 
effort  to  develop  scientific  therapeutics  has  led  to  various 
ways  of  looking  at  the  problem.  We  have  mentioned  the 
fact  that  each  case  of  illness  is  a  problem  with  two  unknown 
quantities,  i.  e.,  the  cause  of  the  illness  and  the  reaction  pow- 
er, i.  e.,  the  resistance  of  the  individual.  The  cause,  in  many 
instances,  may  be  sufficiently  well  known  to  govern  the 
method  of  treatment,  at  least  the  treatment  appears  scien- 
tific if  we  think  only  of  the  cause.  The  possible  weak  point 
in  the  plan  of  treatment  is  the  fact  that  no  consideration  has 
been  paid  to  the  existence  of  the  second  unknown  quantity, 
i.  e.,  the  resistance  of  the  tissues  to  the  disease  as  well  as  to 
the  treatment.  The  treatment  of  typhoid  fever  by  intestinal 
antiseptics  appears  scientific  because  it  appears  to  bring  the 
cause  of  typhoid  and  the  means  of  destroying  it  in  proper 
relation.  The  treatment  has  not  proven  successful  because 
of  the  second  unknown  quantity  and  because  that  which  is 
destructive  to  the  cause  is  likewise  destructive  to  the  tissues. 

The  Problem  as  a  Whole. — The  development  of  scien- 
tific therapeutics  is  evidently  not  easily  accomplished,  even 
when  we  know  the  cause  of  disease.  There  are  those  who 
treat  diseases  and  those  who  treat  individuals,  i.  e.,  those 
who  attack  causes,  with  little  regard  for  the  reactions  of  the 


PRINCIPLES  OF  OStEOPATHY  37 

individual,  and  those  who  aim  to  support  the  reactions  of  the 
individual  without  any  direct  attack  on  the  cause.  It  is  evi- 
dent that  neither  method  is  altogether  right,  hence  scientific 
medicine  is  ever  striving  to  evolve  a  treatment  suited  to  the 
problem  as  a  whole.  Take  for  example  the  problem  of  rid- 
ding the  body  of  an  intestinal  parasite,  such  as  a  tape  worm. 
Methods  of  treatment  differ,  altho  based  on  a  known  cause 
and  a  known  condition  for  elimination  of  the  parasite.  There 
are  many  ways  of  making  the  parasite  sick  enough  to  loose 
its  hold  on  the  walls  of  the  intestine.  The  question  is : 
Which  way  will  be  least  disturbing  to  the  host?  The  prac- 
tice of  osteopathy  is  full  of  such  problems,  the  majority  of 
them  nowhere  near  as  simple  as  the  one  used  as  an  illustra- 
tion. The  human  body  is  disturbed  by  many  specific  causes, 
varying  in  destructive  power,  which  bring  forth  series  of 
symptoms,  which,  taken  together,  give  us  a  picture  of  a  cer- 
tain disease.  To  these  causes  all  human  beings  react  in  ap- 
proximately the  same  way.  The  symptoms  pass  through 
varying  degrees  of  intensity,  run  a  characteristic  course  and 
disappear.  We  recognize  that  the  reaction  power  of  the 
body  has  triumphed  over  the  cause  of  the  disease.  The  fact 
that  the  majority  of  sick  people  get  well  under  all  sorts  of 
treatment  naturally  leads  us  to  believe  that  the  body  is  able, 
in  a  majority  of  instances,  to  conquer  the  cause  of  the  dis- 
ease. Recognition  of  the  healing  power  of  Nature  leads  to 
the  development  of  two  views  as  to  how  disease  should  be 
met.  There  are  those  who  distrust  and  decry  all  therapeutic 
methods.  Such  are  fond  of  pointing  to  past  therapeutic 
failures  and  are,  in  fact,  therapeutic  nihilists. 

Natural  Recovery. — It  is  not  enough  to  recognize  the 
fact  of  recovery.  Wre  want  to  know  how  natural  recovery 
takes  place,  then  we  may  be  able  to  assist,  at  least  not  hin- 
der, the  forces  acting  for  recovery.  The  study  of  structure 
and  function  of  human  tissues  is  the  foundation  for  under- 
standing how  Nature  cures.  We  believe  that  osteopathy 
has  brought,  and  is  now  bringing,  very  valuable  additions 
to  the  sum  of  human  knowledge  as  to  how  Nature  cures.  It 


38  PRINCIPLES  OF  OSTEOPATHY 

is  building  its  portion  of  scientific  therapeutics  based  upon 
a  knowledge  of  causes  and  reactions. 

Extrinsic  Causes  of  Disease. — The  causes  of  disease 
previously  mentioned,  i.  e.,  environmental  conditions,  poi- 
sons, parasites,  etc.,  are  all  external  influences,  in  the  sense 
that  they  are  not  a  part  of  normal  tissue  structures.  The 
causes  noted  especially  in  osteopathic  diagnosis  are  a  part 
of  the  structure  of  the  body.  The  structural  relations  are 
sufficiently  altered  to  compel  the  body  to  react  on  its  own 
structural  imbalance. 

Inherent  Recuperative  Power. — Since  it  has  inherent  re- 
cuperative power  to  overcome  the  effects  of  external  causes 
of  disease,  there  is  no  doubt  but  that  it  usually  survives  lo- 
calized structural  lesions  of  this  inherent  character.  It  adapts 
itself  as  well  to  internal  structural  conditions  as  to  diseases 
produced  by  other  causes.  \Ye  have  noted  the  necessity  of 
a  normal  molecular  intracellular  tension  in  order  to  main- 
tain the  efficiency  of  the  cell,  also  the  necessity  for  proper 
relations  between  the  cells  and  the  circulating  fluids.  Any 
structural  fault  which  interferes  with  this  relationship  com- 
pels the  body  to  react  to  this  fault  either  in  a  way  to  correct 
it,  or,  if  it  threatens  the  life  of  the  whole  body,  get  rid  of  it. 
\Ye  see  in  these  reactions  just  such  phenomena  as  we  ex- 
hibit in  our  social  relations,  i.  e..  a  sick  member  of  the  com- 
munity causes  no  great  reaction  in  the  body  politic  until  his 
illness  menaces  the  whole  people. 

Disturbed  Tissue  Relations. — Osteopathy  emphasizes 
the  disturbances  in  tissue  relations.  It  sees  in  these  both 
predisposing  and  exciting  causes  of  disease;  predisposing,  in 
that  tissue  resistance  to  outside  influences  is  weakened;  ex- 
citing, in  that,  in  many  instances,  the  reactions  take  on  the 
character  of  acute  diseases.  Injuries  are  so  very  frequent 
that  there  is  scarcely  an  individual  who  has  not  put  the  struc- 
tural tissues  to  a  severe  test.  These  strains,  usually  of  suffi- 
cient severity  to  produce  local  distress  and  healing  reactions, 
leave  their  influences,  and  if  a  long  time  for  healing  was  re- 
quired, perhaps  influenced  the  general  statics  of  the  body. 


PRINCIPLES  OF  OSTEOPATHY  39 

The  Biological  Relation  of  Function  and  Structure. — 
The  author  does  not  look  upon  the  so  called  osteopathic  le- 
sion as  being  an  evidence  that  structure  determines  function, 
biologically  considered.  The  structural  lesion  is  an  inter- 
ruption of  the  biological  concept  that  function  fashions  the 
structure.  This  interruption  disturbs  function,  but  the  bio- 
logical law  is  sure  to  assert  itself  in  the  recuperative  process. 
Since  "biology  has  no  statics,"  living  tissues  are  always  be- 
ing rebuilt  to  serve  the  function  which  brought  them  into 
being.  This  ability  to  repair  an  injured  tissue  and  make  it 
serve  the  special  function  for  which  it  was  intended,  is  the 
foundation  for  adaptation  and  compensation,  those  phe- 
nomena which  we  see  exhibited  by  the  body  in  so  many 
forms  in  its  struggle  to  survive. 

The  True  Art  of  Healing. — If  we  can  study  these  phe- 
nomena, understand  what  Nature  is  trying  to  do,  assist  ac- 
cordingly, then  we  are  indeed  physicians.  "In  no  case  can 
anything  appear  in  the  form  of  disease  which  was  not  pre- 
viously present  in  the  body  as  a  predisposition ;  external 
forces  are  able  merely  to  make  this  predisposition  apparent. 
When  the  physician,  by  thorough  observation  and  investi- 
gation, knows  the  conditions  that  influence  a  given  predis- 
position in  a  definite  way,  when  he  is  scientifically  trained 
and  has  a  true  conception  of  hygiene,  and  is  at  once  physi- 
cian and  naturalist,  then  he  is  able  to  cure  disease  by  use  of 
the  very  same  forces  which  serve  to  create  or  alter  the  hu- 
man constitution.  In  this  simple  sense  there  is  a  true  art  of 
healing." 


40  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  II. 

THE  LESION  AS  A  CAUSE. 

Definition. — The  principles  of  osteopathy  take  their  nat- 
ural beginning  in  the  consideration  of  "the  lesion."  The 
word  "lesion"  is  used  by  osteopaths  to  designate  something 
more  than  "an  injury,  hurt  or  wound  in  any  part  of  the  body" 
(Gould).  Any  structural  change  which  affects  the  func- 
tional activity  of  any  tissue  is  called  a  lesion.  There  may  be 
structWral  changes,  abnormal  development,  which  are  very 
evident  to  palpation  but  do  not  affect  functional  activity  and, 
therefore,  are  not  lesions.  A  lesion  is  not  only  a  structural 
change,  but  such  a  change  as  influences  function  detri- 
mentally. Fig.  112  illustrates  a  structural  change  without 
detrimental  influence  on  function,  while  Fig.  113  illustrates  a 
true  lesion.  The  relation  of  these  structural  lesions  to  the 
media  of  communication  and  exchange,  nerves  and  blood 
vessels,  is  believed  to  be  the  chief  element  active  in  pro- 
ducing and  maintaining  functional  disorders.  This  is  the 
central  principle  of  osteopathic  practice. 

Characteristics  of  a  Lesion. — Lesions  may  be  present  in 
any  tissue,  but  their  existence  is  most  easily  recognized  in 
bone,  ligament  and  muscle.  Dislocations  and  subluxations 
of  bones,  thickened  ligaments  and  contracted  muscles  con- 
stitute the  usual  varieties  of  lesions.  A  true  lesion  is  usually 
palpable;  the  functional  disturbance  is  related  anatomically 
and  physiologically;  there  is  hyperaesthesia  at  the  palpable 
area.  These  three  conditions  constitute  the  characteristics 
of  the  lesion  as  it  is  designated'by  the  osteopath.  Its  palpa- 
bility may  vary  between  very  wide  limits;  the  location  of  the 
structural  change  and  functional  derangement  may  be  direct 


PRINCIPLES  OF  OSTEOPATHY  41 

or  indirect,  the  hyperaesthesia  distinct  or  indistinct;  still, 
the  diagnostician  is  justified  in  centering  attention  upon  the 
lesion  if  a  reasonable  amount  of  association  can  be  detected. 

Classes  of  Lesions. — Lesions,  according  to  osteopathic 
theory,  may  be  of  two  classes,  i.  e.,  first,  change  in  size  of 
tissues;  second,  change  in  position.  Generally  speaking,  a 
change  in  size  is  far  more  difficult  to  overcome  than  a  change 
in  position,  because  the  former  is  a  result  of  more  profound 
changes.  Tissues  may  increase  in  size  as  the  result  of  ef- 
forts to  repair  injury,  e.  g.,  the  formation  of  callous  in  bone, 
or  thickening  of  ligaments  following  a  sprain. 

Causes  of  Lesions. — The  causes  of  lesions  fall  under  two 
general  divisions:  First,  violence;  second,  failure  to  react  to 
environment.  In  the  first  division  all  the  lesions  are  primary 
in  character,  i.  e.,  the  violence  immediately  changes  the  rela- 
tions of  structure,  and  this  change  becomes  an  obstruction 
to  vital  activity  of  the  body  fluids.  If  the  lesion  is  not  cor- 
rected by  the  recuperative  power  of  the  body  itself  or  by  out- 
side efforts,  the  change  in  position  is  very  apt  to  become 
complicated  by  a  change  in  size.  The  injury  results  in  thick- 
ening of  the  ligaments  or  other  fibrous  tissues. 

Secondary  Lesions. — The  second  division  of  lesions  is  a 
very  large  one.  These  lesions  develop  as  an  evidence  of  the 
failure  of  the  organism  to  become  perfectly  adapted  to  its 
food,  clothing,  labor  or  general  environment.  They  are, 
therefore,  secondary  in  character  and  must  be  recognized  as 
objective  symptoms  of  one  functional  derangement,  while 
at  the  same  time  they  operate  primarily  to  cause  functional 
derangement  elsewhere.  Thus  they  may  be  removed  by 
manipulation  and  cease  to  act  as  an  active  cause  of  func- 
tional change,  but  will  return  again  so  long  as  environ- 
mental forces  are  overwhelming. 

Effect  of  Violence  or  Fatigue. — The  first  division  or  pri- 
mary lesion  may  result  from  sudden  violence  or  from  a  force 
comparatively  weak  but  long  continued.  In  other  words,  a 
lesion  may  be  developed  immediately,  under  great  force,  or 


42  PRINCIPLES  OF  OSTEOPATHY 

slowly  as  the  result  of  great  fatigue.  An  example  of  a  lesion 
developing  under  fatigue  is  noted  in  the  faulty  positions  as- 
sumed by  the  body  following  prolonged  effort  or  in  perform- 
ing certain  tasks. 

Failure  of  Adaptation. — The  second  division  or  sec- 
ondary lesions  may  result  from  failure  to  react  properly  to 
changes  of  temperature.  The  temperature  of  the  surround- 
ing air  may  be  the  same  at  various  times,  but  the  character 
of  the  clothing  may  necessitate  a  greater  effort  at  adaptation. 
There  must  be  suddenness  in  the  change  of  temperature  or 
clothing  in  order  to  produce  the  lesion,  i.  e.,  the  responsive- 
ness of  the  tissues  must  be  overtaxed.  The  first  effect  of 
failure  of  adaptation  is  the  contraction  of  muscle  and  ac- 
companying sensitiveness.  The  distortion  of  the  bony  struc- 
ture is  consequent  on  the  contraction.  Ordinarily,  if  the 
shock  is  not  too  great,  the  adaptive  forces  of  the  organism 
will  exert  sufficient  power  to  correct  the  condition,  but 
when  the  environment  is  not  suitable  the  lesion  may  be- 
come permanent.  Humidity  or  electrical  conditions  of  the 
atmosphere  may  operate  to  produce  these  lesions. 

Chemical  Causes  of  Spinal  Lesions. — We  have  noted 
that  these  lesions  have  been  discovered  coincident  with  vis- 
ceral disorder.  We  may,  therefore,  safely  assume  that  food 
which  is  too  difficult  of  digestion  or  the  usual  food  taken 
during  fatigue,  may  act  chemically  to  produce  spinal  lesions. 
In  this  instance  they  are  certainly  objective  symptoms  of 
visceral  disease,  but  as  stated  before  they  must  be  primary 
causes  of  other  disorders.  To  remove  such  a  lesion  by  man- 
ipulation is  helpful  to  the  organism,  but  the  patient  must 
know  that  dietetic  indiscretions  or  eating  when  fatigued  was 
the  real  starting  point  of  the  disease.  Here  is  where  dietetic 
and  hygienic  knowledge  must  be  a  portion  of  the  physician's 
therapeutics.  If  the  pointing  out  of  structural  changes  as  a 
result  of  functional  disturbance  due  to  indiscretions  in  eat- 
ing and  other  appetites  will  lead  patients  to  simpler  living, 
the  physician  may  feel  that  he  has  performed  a  duty  more 
valuable  to  the  patient  than  the  removal  of  his  secondary 


PRINCIPLES  OF  OSTEOPATHY  43 

lesions.  There  can  be  no  doubt  but  that  the  removal  of  a 
primary  lesion  due  to  violence  is  absolutely  essential,  but 
when  we  maintain  that  all  lesions  must  be  removed  before 
function  can  right  itself,  we  become  absurd.  Furthermore, 
if  we  contend  that  a  structural  lesion  antedates  all  func- 
tional disturbances  we  make  of  life  a  series  of  accidents,  in- 
stead of  a  force  governed  by  fixed  laws. 

The  Reason  for  the  Persistence  of  a  Lesion. — The  ques- 
tion arises,  why  does  the  muscular  contraction  persist  after 
the  proper  changes  in  habits  have  been  made?  This  ques- 
tion can  not  be  answered  at  present.  Scarcely  one  of  us  will 
voluntarily  make  the  change  in  habits  until  forced  to  do  so 
by  failure  of  the  body  to  respond  to  our  demands.  Many 
things  of  a  sociological  character  are  at  work  to  compel  peo- 
ple to  labor  after  fatigue  is  evident,  to  eat,  sleep  and  dress 
unhygienically.  Viewed  from  this  standpoint,  the  practice 
of  medicine  is  a  problem  in  sociology.  The  original  irrita- 
tion which  causes  the  tension  probably  causes  more  or  less 
congestion  of  blood.  The  congestion  results  in  over-growth 
of  tissue,  which  becomes  a  fixed  condition  maintaining  the 
lesion,  i.  e.,  it  is  a  portion  of  the  lesion. 

The  Sequence  of  Lesion  Phenomena. — We  have  con- 
sidered three  points  concerning  lesions — hyperaesthesia, 
muscular  contraction,  and  subluxation.  They  have  been 
considered  in  this  order  merely  on  account  of  historical  ref- 
erence. In  osteopathic  practice,  they  are  reversed.  We  note 
first  the  structure,  then  the  tension  which  accompanies  the 
change  in  structure,  then  the  hyperaesthesia. 

Variations  in  Development. — It  is  not  uncommon  to  find 
changes  from  the  usual  forms  of  the  bones.  Sometimes  these 
changes  may  be  very  deceptive,  but  when  analyzed  with 
reference  to  the  existence  of  functional  disorder  in  the  area 
of  their  normal  influence  and  the  presence  of  hyperaesthesia, 
they  will  be  recognized  as  morphological  changes  due  to 
natural  causes.  Lesions  which  might  have  been  active  at  a 
former  time  are  sometimes  nonactive  on  account  of  laws  of 
accommodation  which  are  always  active  in  the  body.  If  the 


44  PRINCIPLES  OF  OSTEOPATHY 

body  has  succeeded  in  recuperating  from  the  effect  of  these 
lesions,  it  is  unwise  to  disturb  them.  As  an  example  of  an 
accommodated  lesion,  \ve  may  mention  the  formation  of  a 
new  socket  for  the  head  of  the  femur,  following  dislocation. 
There  are  variations  in  development  all  through  the  body, 
and  each  physician  should  strive  to  become  acquainted  with 
them. 

Palpation  of  a  Lesion. — The  first  sign  of  a  lesion  is 
noted  by  palpation,  i.  e.,  the  change  in  structure  is  felt.  Ac- 
cording to  what  we  have  just  said,  this  is  not  sufficient  evi- 
dence of  the  existence  of  an  active  lesion.  It  must  be  ac- 
companied by  other  signs.  First,  try  to  eliminate  the  ap- 
parent existence  of  the  lesion  by  having  the  patient  "assume 
different  positions."  Second,  note  whether  the  bony  land- 
marks in  that  area  vary  from  the  normal.  Third,  note 
whether  the  lesion  causes  the  patient  to  assume  any  special 
attitude.  Fourth,  test  the  amplitude  of  movement  in  the 
articulation  to  determine  the  changes  in  its  extent.  If  there 
is  perfect  flexibility  it  is  scarcely  probable  that  a  lesion  ex- 
ists, for  an  active  lesion  is  quite  inconceivable  without  ten- 
sion. Fifth,  feel  of  the  soft  parts  of  the  joint,  muscles  and 
connective  tissues.  Note  any  swelling  or  change  in  tempera- 
ture. Sixth,  inspect  the  surface  as  to  color  and  texture. 
Seventh,  test  sensibility  by  pressure.  Ordinarily  an  exam- 
ination of  the  body  for  lesions  consists  in  comprehensive 
palpation,  which  notes  synchronously  the  existence  of  posi- 
tional change,  tension,  temperature,  swelling  and  sensitive- 
ness. The  existence  of  tension  is  sufficient  evidence  of  de- 
crease of  flexibility.  When  violence  is  the  cause  of  the  le- 
sion, it  is  necessary  to  correct  structure  directly.  When  the 
osseous  lesion  is  the  result  of  muscular  tension  due  to  reflex 
stimulation,  methods  differ  according  to  the  viewpoint  of  the 
physician.  Some  manipulate  for  direct  reduction,  others  re- 
lax muscles  and  thus  remove  the  cause  of  the  osseous  lesion. 
The  really  comprehensive  plan  should  take  into  account  the 
cause  of  the  tension  which  occasions  the  osseous  lesion. 
Having  done  this,  the  physician  may  manipulate  the  lesion 


PRINCIPLES  OF  OSTEOPATHY  45 

to  secure  direct  reduction  with  the  feeling  that  the  problem 
has  been  undertaken  wisely. 

Description. — Theories  of  the  causation  of  disease  are 
capable  of  being  spun  out  to  the  point  where  concrete  use- 
fulness is  very  doubtful.  In  order  that  we  may  not  wander 
too  far  in  theoretical  speculation,  we  will  seek  to  keep  the 
phenomena,  which  we  are  trying  to  describe,  of  such  a  tan- 
gible character  that  the  reader  will  not  have  to  draw  on  the 
imagination. 

Find  the  Lesion. — Osteopathy  has  developed  as  a  school 
of  medicine  exploiting  "the  lesion"  as  a  cause  of  disease 
and  its  correction  as  the  efficient  cure  of  disease.  This 
theory  has  been  so  enthusiastically  adhered  to  that  many 
have  been  more  than  willing  to  attribute  failure  to  cure  a 
given  case  as  due  to  the  practitioner's  inability  to  find  or  cor- 
rect the  lesion.  The  desire  to  maintain  the  adequacy  of  a 
theory  is  thus  apparent.  This  book  is  written  to  present  the 
usefulness  of  osteopathy  but  not  the  extremes  of  theoretical 
speculation. 

Inspection  of  the  Back. — In  order  that  we  may  quickly 
have  before  us  characteristic  lesion  phenomena  for  discus- 
sion and  elucidation,  let  us  observe  some  well  recognized  pe- 
culiarities noted  in  the  inspection  of  the  dorsum  of  the  body. 
A  mature  male  patient,  stripped  for  inspection,  will  present, 
as  a  general  rule,  some  peculiarities  which  the  trained  diag- 
nostician will  recognize  as  adaptation  due  to  labor  or  mode 
of  life.  Closer  inspection  of  the  spine,  as  to  its  curves,  will 
show  adaptation  of  even  more  significance,  i.  e.,  to  body 
weight,  general  vitality  and  visceral  conditions.  As  a  rule 
the  diagnostician  is  trained  to  note  these  latter  conditions 
from  other  points  of  view.  The  point  is  here  emphasized 
that  the  spinal  column  is  a  good  recorder  of  all  these  things. 

Palpation  of  Vertebral  Structures. — Digital  palpation  of 
the  vertebral  and  paravertebral  structures  will,  in  most  cases, 
show  some  degree  of  localized  unilateral  deviation  in  verte- 
bral alignment  or  muscular  tension.  These  apparent  changes 
from  what  we  conceive  as  the  ideal  normal  are  present  in 


46  PRINCIPLES  OF  OSTEOPATHY 

practically  all  people,  sick  or  well.  It  remains,  therefore, 
necessary  that  \ve  add  to  these  physical  changes  something 
of  a  determining  character  in  order  to  recognize  an  active 
lesion.  Tenderness  to  pressure  is  the  determining  sign. 
Having  located  a  lesion,  i.  e.,  an  osseous  deviation  with  mus- 
cular tension  and  tenderness  in  the  same  spinal  segments, 
we  can  now  proceed  to  analyze  it  with  reference  to  its  ex- 
istence as  cause  or  effect.  The  spinal  vertebral  lesion  just 
noted  may  involve  two  or  more  vertebrae  with  their  at- 
tached tissues.  Some  observers  claim  that  a  lesion  of  a 
single  vertebra  is  rare.  Since  osteopathy  has  fostered  the 
view  that  structure  affects  function  in  preference  to  the  re- 
verse, the  author  feels  justified,  solely  by  historical  consider- 
ations, in  beginning  all  analyses  of  lesions  from  that  view- 
point. It  is  candidly  understood  that  in  doing  this  the 
author  is  not  holding  a  brief  for  either  side  of  any  contro- 
versy which  circles  about  the  question  whether  the  egg  pre- 
ceded the  chicken  or  the  reverse. 

History  of  Accident. — In  any  case  under  examination 
the  diagnostician  desires  to  uncover  the  history  of  the  lesion, 
hence  the  most  direct  question  possible  is  asked,  i.  e.,  "Is 
there  any  history  of  accident?"  If  a  history  of  accident  is 
given  having  direct  bearing  on  the  lesion  under  considera- 
tion then  we  are  quite  justified  in  believing  it  to  be  the  pri- 
mary cause  of  disturbed  function.  For  example,  a  patient 
when  attempting  to  alight  from  a  street  car  just  before  it 
stopped,  found  his  footing  insecure  and  hence  clung  to  the 
handrail  of  the  car  with  one  hand  in  an  effort  to  protect 
himself.  The  forward  motion  of  the  car  rotated  him  and 
wrenched  his  back.  He  was  able  to  go  to  his  home  without 
feeling  more  than  a  sense  of  weakness  and  pain  in  the  area 
of  the  dorso-lumbar  articulation.  The  next  morning  he  was 
quite  unable  to  rise.  Examination  showed  great  muscular 
tension  in  the  muscles  controlling  the  movement  of  the 
twelfth  dorsal  and  first  lumbar.  Pressure  on  the  spinous 
processes  of  these  vertebrae  caused  intense  pain.  The  bowels 
became  constipated  and  the  cutaneous  areas  supplied  by  the 


PRINCIPLES  OF  OSTEOPATHY  47 

twelfth  dorsal  and  first  lumbar  pairs  of  spinal  nerves  gave 
some  subjective  symptoms  of  being  disturbed.  This  case 
recovered  in  a  few  weeks  under  the  influence  of  hot  packs  to 
the  injured  area,  rest  in  bed,  and  after  acute  soreness  abated, 
passive  motion.  This  case,  for  many  years,  has  had  attacks 
of  "lumbago."  These  attacks  usually  follow  changes  in  the 
weather  and  some  exertion  beyond  the  ordinary.  The  lesion 
always  exhibits  its  old  characteristics,  viz.,  tenderness,  mus- 
cular rigidity  and  loss  of  motion  in  the  arthrodial  joints  be- 
tween the  twelfth  dorsal  and  first  lumbar.  Usually  an  osteo- 
pathic  treatment  to  establish  relaxation  and  movement  is 
sufficient  to  secure  rapid  recovery. 

Traumatic  Lesion. — We  have  in  this  case  a  condition 
similar  to  the  results  of  a  sprained  wrist  or  ankle  This  is  a 
case  of  such  evident  traumatic  origin  that  no  one  would 
think  of  it  from  any  other  standpoint.  The  lesion  is  a  char- 
acteristic one,  derived  in  a  characteristic  manner  and  fulfills 
our  classical  picture  of  localized  spinal  injury.  It  is  fairly 
mild  in  its  disturbance  of  function  of  the  nerves  from  the  in- 
jured area.  It  was  recovered  from  to  such  an  extent  that  the 
patient  has  considered  himself  well  except  at  such  times  as 
the  formerly  injured  tissue  failed  to  function  properly  under 
somewhat  unusual  conditions.  There  has  never  been  com- 
plete recovery  of  function  in  the  articulation.  This  is  evi- 
denced by  partial  loss  of  flexion  and  extension,  hence  "the 
lesion"  is  always  apparent  to  the  trained  sense  of  touch. 
This  lesion  presents  the  same  characteristics  so  commonly 
noted  in  peripheral  joints  which  have  been  sprained  and  re- 
covered from  with  partial  loss  of  motion.  It  is  usually  many 
months  before  the  point  of  attachment  of  a  strained  liga- 
ment is  free  from  sensitiveness  to  pressure  or  tension. 

Weight  Carrying  and  Balancing  Function  Disturbed. — 
With  an  injury  of  this  character  located  where  it  has  a 
weight  carrying  and  balancing  function  to  perform,  forming 
part  of  the  protective  covering  of  the  spinal  cord  and  its 
membranes,  as  well  as  being  a  part  of  the  wall  of  a  visceral 
cavity,  there  are  many  far-reaching  influences  which  may  be 


48  PRINCIPLES  OF  OSTEOPATHY 

attributed  to  it.  The  rigidity  which  nature  manifests  first 
as  a  protective  reaction,  i.  e.,  to  prevent  motion  in  the  in- 
jured part,  will  be  maintained  as  a  constant  factor  in  any 
case  of  joint  injury  which  heals  with  a  partial  return  of  mo- 
tion. By  this  is  meant  that  before  the  motion  of  the  joint 
reaches  its  limit  the  muscles  assume  the  function  of  liga- 
ments, so  as  to  protect  the  weakened  ligaments.  This  ac- 
tion of  the  muscles  we  note  as  a  protective  rigidity  which 
under  the  influence  of  passive  motion  may  be  absent  but  re- 
appears when  the  joint  is  put  through  its  voluntary  func- 
tional tests.  Thus  the  fact  that  the  lesion  under  discussion 
involves  structures  forming  a  part  of  the  weight  carrying 
and  balancing  mechanism  of  the  body  makes  it  more  diffi- 
cult of  recovery.  In  order  to  protect  it  from  movement 
rigidity  exists  in  segments  just  above  and  below  it%  A  lesion 
at  the  point  mentioned  will  tend  to  produce  a  straight  spinal 
column  because  it  is  situated  at  the  junction  of  two  curves, 
the  dorsal  posterior  and  the  lumbar  anterior.  Any  exaggera- 
tion of  these  curves  necessitates  greater  movement  in  this 
joint.  Therefore,  if  this  joint  be  injured  and  its  movement 
limited  there  is  greater  rigidity  in  both  curves  in  order  to 
protect  the  injured  joint  through  which  their  compensating 
movements  operate.  The  tension  of  the  posterior  spinal 
muscles  is  met  by  counter-balancing  contraction  of  the  psoas 
magnus,  the  diaphragm  and  the  abdominal  muscles.  The 
tension  of  the  diaphragm  results  in  lessened  respiration.  The 
tension  of  the  abdominal  muscles  subtracts  one  factor  in  the 
maintenance  of  bowel  action.  Lessened  oxygenation  and 
elimination  are  thus  possible  results  on  a  purely  mechanical 
basis.  To  compensate  for  these  decreases  the  whole  body 
metabolizes  at  a  slower  rate  and,  without  the  sympathetic 
nervous  system  is  vigorous,  the  decrease  in  visceral  activity 
soon  makes  itself  so  apparent  that  the  patient  may  be  con- 
sidered constitutionally  ill.  Thus  it  appears  that  a  spinal 
lesion  may  influence  body  metabolism  adversely  as  a  result 
of  the  natural  healing  reaction  as  manifested  in  rigidity.  The 
decrease  of  rhythmical  movement  in  the  walls  of  the  abdo- 


PRINCIPLES  OF  OSTEOPATHY  49 

men  and  thorax  is  the  immediate  consequence  of  spinal  rig- 
idity. These  functions  are  less  interfered  with  when  the 
weight  carrying  function  of  the  spine  is  least  called  upon, 
hence  the  horizontal  position  is  naturally  assumed  to  lessen 
pain  and  get  rid  of  the  demand  for  compensatory  tensions. 

Lack  of  Physiological  Rest. — While  these  injuries  are 
acute  we  note  easily  the  compensatory  reactions  just  de- 
scribed, but  no  doubt  the  majority  of  such  cases  feel  the 
press  of  economic  necessity  and  hence  try  to  adapt  them- 
selves to  labor  through  hours  more  than  sufficient  to  pro- 
duce a  fatigue  akin  to  sickness.  The  lesion  develops  a  chro- 
nicity,  or  rather  has  never  had  a  chance  to  heal  under  the 
benign  influence  of  physiological  rest.  This  chronic  lesion 
necessitates  permanent  compensatory  changes  such  as  we 
have  noted.  This  patient  develops  periodical  digestive  weak- 
ness, synchronous  with  his  times  of  fatigue.  He  visits  a  doc- 
tor and  from  then  on  "suffers  many  things  of  many  physi- 
cians." Through  time  and  the  compensatory  changes  in 
this  patient's  body  the  original  lesion  and  its  significance  are 
lost  to  view.  The  effort  made  to  correct  or  palliate  the  di- 
gestive disturbance  probably  has  no  reference  to  anything 
but  the  prominent  symptoms.  It  is  such  cases  as  these, 
suffering  from  chronic  illness,  whose  history  of  traumatic 
lesion  is  discovered  by  the  osteopathic  examination,  which 
have  given  prestige  to  osteopathic  therapeutics.  The  treat- 
ment given  by  the  osteopath  to  this  old  lesion  reestablishes 
movement  in  the  joint  and,  therefore,  the  compensatory  ten- 
sions in  the  back,  abdomen  and  chest  are  lessened. 

Influence  on  Circulation  and  Innervation. — Having  thus 
followed  the  mechanical  influence  of  this  traumatic  lesion 
through  some  of  its  compensations  we  can  with  profit  turn 
our  attention  to  the  far  more  subtle  influences  upon  circula- 
tion and  innervation.  The  trauma  under  consideration  has 
been  sufficient,  in  some  degree,  to  rupture  tissue  continuity 
and  therefore  requires  increase  of  circulation  for  repair. 
The  swelling,  occasioned  by  the  congestion  of  the  circula- 
tion, being  under  the  spinal  apponeurosis,  does  not  evidence 


50  PRINCIPLES  OF  OSTEOPATHY 

its  presence  by  a  localized  tumefaction.  Some  fibers  of  an 
intrinsic  spinal  muscle,  i.  e.,  one  of  the  fifth  layer,  according 
to  Gray's  grouping,  has  been  injured,  hence  our  repair  in- 
flammation is  deep  seated.  The  deeper  seated  the  lesion, 
the  more  pressure  will  be  exerted  on  the  branches  of  nerve 
trunks  emerging  from  the  intervertebral  canal  and  the  more 
likelihood  will  there  be  that  the  patient  will  complain  of 
some  symptoms  of  a  character  which  might  be  interpreted 
as  of  central  origin,  especially  if  bilateral.  The  subjective 
symptoms,  pain  and  paraesthesia,  in  the  area  of  cutaneous 
distribution  of  the  twelfth  dorsal  nerve  are  usually  unilat- 
eral, hence  showing  that  the  lesion  causes  a  peripheral  neu- 
ritis or,  at  least,  a  pressure  on  the  nerve  sufficient  to  cause 
the  brain  to  register  as  though  the  peripheral  distribution 
of  this  nerve  was  irritated. 

Segmental  Coordination. — A  segment  of  the  spinal  cord 
coordinates  the  impulses  reaching  it  over  its  afferent  fibers, 
hence,  in  the  case  of  our  lesion,  the  bombardment  of  this 
segment  with  impulses  from  the  injured  tissue  as  well  as 
from  the  nerves  subjected  to  pressure  as  a  result  of  the  re- 
pair inflammation  will  cause  efferent  impulses  to  be  sent  to 
somatic  and  splanchnic  areas  supplied  from  this  segment. 
These  outgoing  impulses  are  influencing  motion,  secretion, 
nutrition  which  are  probably  disturbed  if  the  sensory  nerve 
impulse  which  calls  forth  the  reaction  is  a  disturbed  one. 
It  is  hardly  probable  that  reactions  of  the  kind  here  men- 
tioned tend  to  remain  active  within  one  spinal  segment. 
The  nerve  centers  involved  are  vertical,  i.  e..  extend  through 
one  or  more  segments  and  hence  our  reactions  tend  to 
spread.  As  soon  as  visceral  activity  is  disturbed  by  vas- 
omoter  changes  a  train  of  reflexes  of  a  compensatory  char- 
acter are  initiated  and  without  we  hold  firmly  in  mind  the 
character  and  location  of  the  lesion  and  realize  the  probable, 
as  well  as  possible,  compensatory  reactions  of  a  mechanical, 
circulatory  and  nervous  character  dependent  upon  it,  we  are 
quite  apt  to  be  led  astray  by  the  boldness  with  which  some 
obscurely  related  symptom  crowds  its  way  into  the  fore- 


PRINCIPLES  OF  OSTEOPATHY  51 

ground  of  our  attention.  The  persistence  with  which  many 
of  the  older  osteopaths  have  worked  upon  the  lesion  and  re- 
fused to  be  led  away,  in  fruitless  efforts  to  palliate  symp- 
toms, has  contributed  much  to  the  success  of  their  school. 

Example  of  Fatigue. — Another  phase  of  the  lesion  as  a 
tenable  cause  of  disease  is  found  in  those  cases  whose  struc- 
ture suffers  on  account  of  fatigue  or  effort  to  become 
adapted  to  position.  We  will  take  two  lesions  commonly 
associated,  i.  e.,  muscular  tension  with  a  variable  amount  of 
distortion  over  the  splanchnic  area,  and  muscular  tension 
centered  over  one  or  all  of  the  upper  three  cervical  verta- 
brae.  A  bookkeeper  fatigues  his  back  muscles  by  his  posi- 
tion. The  effort  to  see  clearly,  especially  if  there  is  any  in- 
trinsic defect  of  vision  or  of  the  coordinating  power  of  the 
occular  muscles  requires  compensatory  action  of  the  cervical 
muscles  to  maintain  the  head  in  the  most  favorable  position 
for  seeing.  The  fatigue  resulting  from  many  hours  of  this 
compensatory  effort,  supplemented  by  other  events  of  daily 
life,  produces  a  so-called  "bony  lesion,"  usually  about  the 
second  or  third  cervical  or  even  as  low  as  the  fourth  dorsal. 
By  carrying  the  weight  of  the  head  forward  of  the  center  of 
the  body  the  strain  on  the  extensor  cervical  muscles  is  eased 
somewhat  by  rounding  the  shoulders,  depressing  the  thorax, 
shortening  the  distance  between  the  end  of  the  sternum, 
costal  arches  and  the  pelvic  brim,  thus  relaxing  the  abdom- 
inal muscles  arid  permitting  gastro  and  enteroptosis.  This 
sagging  of  the  stomach  and  bowel  must  be  checked  if  pos- 
sible, hence  the  extensor  muscles  over  the  splanchnic  area 
contract  to  maintain  the  normal  erect  attitude,  but  fail  even- 
tually because  the  body  is  not  planned  to  sustain  the  weight 
of  the  head  in  a  position  constantly  off  the  center  of  the 
body.  This  illustrates  the  gradual  development  of  lesions 
due  to  efforts  of  adaptation. 

Loss  of  Muscular  Tone. — Loss  of  tone  in  muscles  will 
allow  those  tissues  to  which  they  are  attached  to  yield  to 
the  force  of  gravity  and,  hence,  lesions  will  be  produced.  As 
example,  one  of  my  surgical  cases  complained  bitterly,  on 


52  PRINCIPLES  OF  OSTEOPATHY 

the  third  day  after  a  hysterectomy  of  pain  in  the  back  and 
at  the  lower  end  of  the  abdominal  wound.  Inspection  of  the 
wound  showed  nothing  unusual.  The  course  of  the  pain 
was  examined  and  it  was  found  to  follow  the  course  of  the 
twelfth  dorsal  nerve.  The  feebleness  of  the  patient  allowed 
all  her  tissues  to  sag,  with  the  result  that  the  right  twelfth 
rib  lay  against  the  transverse  process  of  the  first  lumbar  ver- 
tebrae. A  pressure  thus  exerted  on  the  twelfth  dorsal  nerve 
produced  pain  in  the  area  of  its  distribution.  A  small  pad 
of  gauze  and  cotton.  sufficient  to  keep  the  rib  away  from  the 
transverse  process  for  a  few  days  until  general  body  nutri- 
tion reasserted  its  tonic  effect,  was  sufficient  for  relief. 

As  heretofore  stated,  it  isn't  the  acute  lesion,  so  easily 
recognized,  that  has  contributed  so  much  prestige  to  oste- 
opathy. It  is  the  lesion  having  been  overlooked  or  mis- 
treated and  considered  a  negligible  quantity  as  a  causative 
factor. 

Experimental  Lesions. — As  a  foundation  for  better  clin- 
ical observation  and  understanding,  experiments  have  been 
conducted,  notably  by  Dr.  Louisa  Burns,  in  the  Physiologi- 
cal Laboratory  of  the  Pacific  College  of  Osteopathy,  Los 
Angeles,  and  by  Dr.  Carl  M.  McConnell  of  Chicago.  These 
experiments  consisted  in  producing  artificial  lesions  on  small 
animals,  usually  dogs,  and  noting  the  immediate  and  remote 
effects,  then  killing  the  animals  and  making  a  careful  path- 
ological study  of  the  changes  in  the  lesioned  tissues.  Dr. 
McConnell's  description  of  the  manner  in  which  he  produced 
experimental  lesions  is  as  follows :  "The  production  of  the 
lesion  is  a  simple  but  still  very  important  matter.  It  can- 
not be  performed  successfully  in  a  haphazard  manner.  Strict 
attention  to  the  thorough  relaxation  of  tissues  about  the 
field  of  operation  and  definite  application  of  mechanical  prin- 
ciples are  demanded.  After  selecting  a  healthy  animal  (a 
small  or  medium  size  dog  is  best),  surgical  anesthesia  is 
instituted.  Complete  relaxation  under  anasthesia  is  neces- 
sary. Following  this,  further  relaxation  of  the  area  of  in- 
tended operation  by  traction  is  essential  for  ease  of  lesion 


PRINCIPLES  OF  OSTEOPATHY  53 

production.  Next,  having  determined  the  character  of  osteo- 
pathic  lesion  desired,  that  is,  right  or  left  rotation,  or  hyper- 
extension,  or  hyperflexion,  or  combination  of  these,  the 
second  essential  is  to  apply  definite  mechanical  principles. 
Bringing  the  fulcrum  to  bear  at  just  the  desired  point  when 
the  tissues  are  thoroughly  relaxed  is  as  necessary  in  pro- 
ducing a  lesion  as  in  adjusting  one.  Much  strength  can  be 
wasted  if  the  leverage  is  not  right ;  otherwise  comparatively 
few  pounds  exertion  will  accomplish  the  result.  A  simple 
way  is  to  place  the  animal  flat  upon  its  belly,  completely  un- 
der surgical  anesthesia,  then  while  an  assistant  bears  down 
with  his  thumbs  upon  the  selected  vertebra  the  operator 
grasps  the  animal  by  the  rear  legs  and  exerts  traction  in  line 
with  the  spinal  column  until  the  spinal  muscles  thoroughly 
relax  and  stretch,  then  immediately,  while  still  maintaining 
the  traction,  hyperextend  and  rotate  the  spine  until  the  de- 
sired point  is  felt  to  give  and  slip.  It  is  simply  a  question 
of  applying  the  indicated  mechanics.  Various  leverages 
may  be  utilized.  Frequently  we  place  a  small  block  trans- 
versely under  the  animal,  especially  in  producing  rib  lesions, 
in  order  to  help  separate  the  ribs,  as  well  as  to  secure  a  sta- 
ble fulcrum. 

"The  traumatism  is  not  carried  to  a  point  where  tis- 
sues are  torn  or  lacerated.  The  object  is  to  obtain  a  slight 
slipping  or  maladjustment  of  the  articular  surfaces.  If  done 
correctly,  that  is,  specifically,  little  force  is  required.  The 
immediate  noticeable  results  are  malalignment  of  the  verte- 
brae, malposition  of  the  ribs  corresponding  to  the  deranged 
vertebrae,  if  the  lesion  is  a  dorsal  one,  and  contraction  of 
the  spinal  muscles  of  the  same  segments.  These  changes 
are  readily  palpated.  After  recovery  from  the  anesthesia 
and  during  the  ensuing  time  the  above  characteristics  are 
evident  with  the  added  ones  of  tenderness  and  rigidity. 
Muscular  contraction  usually  subsides,  but  not  always,  un- 
til only  the  deep  spinal  muscles  are  palpably  contracted  and 
these  corresponding  to  the  local  lesion.  In  some  cases  the 
animal  exhibits  upon  movement  that  the  back  is  stiff  and 


54  PRINCIPLES  OF  OSTEOPATHY 

tender;  others  do  not  and  shortly  show  no  apparent  ill  ef- 
fects. Later  on,  a  number  present  more  or  less  systemic  dis- 
turbances, depending  upon  the  locality  of  the  lesion.  The 
periods  of  observation  have  ranged  from  three  to  eighty 
days,  that  is,  the  time  from  production  of  the  lesion  to 
autopsy." 

Loss  of  Motion. — The  moveable  vertebral  and  costo- 
vertebral  articulations  are  arthodial,  i.  e.,  gliding,  hence  any 
change  in  one  of  these  articulations,  short  of  dislocation,  is 
in  a  normal  direction.  In  other  words,  the  lesions  which 
we  recognize  are  partial  fixations,  hence  it  isn't  the  position 
which  constitutes  the  lesion  so  much  as  it  is  the  loss  of  mo- 
tion, i.  e.,  the  loss  of  function  and  the  exaggerated  muscu- 
lar contraction  which  maintains  the  fixation  and  the  charac- 
ter of  the  injury  which  is  the  cause  of  these  changes. 

Necessity  for  Study  of  Structure. — Based  on  this  idea 
of  what  the  lesion  is  we  must  study  the  normal  structure 
and  function  of  every  vertebral  and  costo-vertebral  articula- 
tion, so  that  we  may  recognize  not  only  the  compensatory 
changes  on  the  immediate  group  affected,  but  also  those 
widespread  compensations  of  a  mechanical,  circulatory  and 
nervous  character  which  are  part  of  every  reparative  and 
adaptive  effort  of  the  body.  Since  pathology  is  the  study 
of  the  perversions  of  the  normal  we  can  not  understand 
what  the  body  is  trying  to  do  in  any  given  case  without 
taking  into  account  the  successes  and  failures  of  compensa- 
tion as  are  made  evident  bv  this  division  of  medical  science. 


PRINCIPLES  OF  OSTEOPATHY  55 


CHAPTER  III. 

THE  LESION  AS  AN  EFFECT. 

Analysis  of  the  Causes  of  Lesions. — As  previously 
noted,  the  inspection  of  the  vertebral  and  paravertebral  tis- 
sues in  almost  all  cases  of  illness  involving  the  trunk  of  the 
body  will  show  physical  signs  of  compensatory  reactions. 
These  physical  signs  we  call  "lesions."  They  seem  to  be 
identical  in  character  with  those  which  we  noted  as  trau- 
matic lesions,  i.  e.,  there  is  deviation  in  osseous  alignment, 
muscular  contraction  and  hyperaesthesia.  It  may  be  impos- 
sible to  secure  from  the  patient  any  history  of  trauma  as  the 
foundation  of  this  lesion,  therefore  two  explanations  are 
open  to  us ;  either  we  must  wilfully  hold  to  the  hypothesis 
that  a  trauma  did  occur  of  so  light  immediate  effect  as  to 
escape  the  notice  of  the  patient,  or  use  the  facts  of  anatomy 
and  physiology  to  build  up  a  rational  theory  of  normal  reac- 
tions. It  is  much  easier  to  declare  trauma  as  the  cause  than 
analyze  the  protective  reactions  of  the  body.  This  fact  has 
led  the  exponents  of  the  various  forms  of  spinal  adjustment 
to  explain  every  lesion  by  claiming  an  obscure  trauma  as  the 
cause.  Since  no  one  ever  goes  through  life  without  many 
slips,  falls  and  other  strains  which  can  be  called  to  mind,  it 
is  easy  for  the  patient  to  be  convinced  that  some  remote  ex- 
perience of  this  kind  is  in  fact  the  foundation  for  all  the 
trouble. 

The  Attractiveness  of  the  Traumatic  Lesion  Theory. — 
The  theory  that  an  obscure  trauma  in  the  spinal  tissues  is 
the  essential  and  adequate  cause  of  bodily  disorders  is  cap- 
tivating both  to  the  physician  and  the  patient.  It  has  so 
many  definite  elements  which  are  evident  both  to  the  mind 


56  PRINCIPLES  OF  OSTEOPATHY 

of  the  physician  and  of  the  patient.  The  physician's  palpat- 
ing finger  feels  the  change  in  osseous  alignment  and  muscu- 
lar tone.  The  patient  recognizes  the  difference  in  sensitive- 
ness between  this  lesion  area  and  those  outside  the  lesion 
influence.  Specific  manipulation  having  for  its  aim  the  cor- 
rection of  alignment  in  the  lesioned  area  gives  so  frequently 
almost  instant  sense  of  relief  that  it  is  no  wonder  physician 
and  patient  becojne  convinced  that  the  hypothesis  of  trauma 
is  correct.  Under  the  influence  of  such  a  theory  as  this  our 
osteopathic  literature  is  well  spiced  with  statements  tending 
to  belittle  the  influence  of  all  other  causes  of  disease.  The 
writer  wishes  to  emphasize  the  fact  that  lesions  can  be  di- 
vided into  two  great  classes,  i.  e.,  primary  and  secondary. 
The  first  class  is  made  up  of  those  of  traumatic  origin  and 
are  undoubtedly  causes  of  disorder  in  their  areas  of  influ- 
ences. The  second  class  is  made  up  of  those  lesions  which 
are  physical  sign  of  the  body's  efforts  at  adaptation  and 
compensation. 

Classification  of  Lesions.  —  A  given  lesion  can  be 
classed  as  primary  or  secondary  only  after  careful  study  of 
all  those  factors  which  constitute  the  history  and  symptom- 
otology  of  the  case.  Visceral  lesions  cause  muscular  con- 
tractions in  the  spinal  area  from  which  they  receive  their 
cerebro-spinal  nerve  communications.  They  also  cause  pain 
in  areas  of  higher  sensibility,  cutaneous  areas,  with  which 
they  are  associated  by  innervation  from  the  same  segment 
of  the  spinal  cord.  These  referred  pains  and  contractions  of 
spinal  muscles  are  beginning  to  be  recognized  by  specialists 
in  pulmonary,  digestive  and  renal  diseases.  There  has  been 
no  well  ordered  effort  to  coordinate  the  facts  which  lie  at  the 
foundation  of  these  phenomena.  It  is  hoped  that  we  may 
make  for  our  students  a  beginning  in  this  work  by  what 
is  to  follow. 

Examples  of  Secondary  Lesions. — As  examples  of  var- 
ious secondary  lesions  we  will  call  attention  to  the  lesion 
phenomena  found  usually  to  be  synchronous  with  envolv- 
ments  of  some  of  the  organs  of  the  body.  Rather  than  rush 


PRINCIPLES  OF  OSTEOPATHY  57 

into  an  analysis  of  lesions,  we  deem  it  more  to  the  student's 
interest  to  have  a  clear  picture  of  the  phenomena  we  desire 
to  analyze  later  on.  Our  practitioners  who  are  devoting 
much  time  in  treating-  the  eye  recognize  that  in  diseases  of 
the  eye  and  orbital  tissues  there  are  points  in  the  neck  which 
are  rarely  free  from  tenderness.  Along  with  the  tenderness 
are  found  muscular  contraction  and  malalignment,  these 
completing  our  trinity  of  localized  lesion  phenomena.  Such 
lesions  may  be  located  as  low  as  the  second  dorsal. 

The  Spinal  Lesion  an  Objective  Symptom. — Disturb- 
ance of  circulation  in  the  tonsil  is  associated  with  spinal  le- 
sions. These  lesions  vary  in  number  and  extent  according 
to  whether  the  disease  process  is  simple  and  decidedly  local, 
or  is  of  enough  severity  to  produce  constitutional  symptoms 
such  as  chill,  fever,  etc.  The  spinal  lesions  multiply  and  in- 
tensify in  proportion  to  the  extent  and  severity  of  the  dis- 
turbance of  the  body.  This  is  the  case  no  matter  in  what 
organ  or  tissue  our  original  disturbance  made  its  appear- 
ance. Just  as  the  symptom  complex  varies  according  to  the 
'severity  of  a  disease,  so  the  spinal  lesions  proportion  them- 
selves in  like  manner.  Therefore,  in  this  sense,  spinal  lesions 
are  physical  signs:  objective  and  subjective  evidence  of  dis- 
turbance in  tissues  innervated  by  branches  of  nerves  from 
the  same  segment  of  the  spinal  cord. 

•  Visceral  Reflexes. — Each  viscus,  or  localized  tissue, 
such  as  glands,  mucous  or  serous  membranes,  tend  to  es- 
tablish reflex  lesions  in  the  spinal  area  tissues  which  are 
supplied  with  nerves  from  the  same  spinal  cord  segment  as 
they  themselves  are  supplied.  In  proportion  to  the  amount 
of  compensatory  assistance  required  by  any  organ  or  tissue 
from  those  parts  of  the  body  ordinarily  called  upon  for  such 
assistance,  our  spinal  lesion  increases  in  extent  and  inten- 
sity. As  a  common  example  of  the  foregoing,  the  stomach 
may  fail  to  do  its  work  thoroughly  and  thus  throw  added 
work  on  the  small  intestine  and  its  related  glands,  liver  and 
pancreas.  If  these  are  somewhat  overtaxed  by  their  com- 
pensatory efforts,  our  spinal  lesion  which  represented  the 


58  PRINCIPLES  OF  OSTEOPATHY 

stomach,  extends  further  down  over  the  spinal  areas  from 
which  the  liver  and  pancreas  receive  a  portion  of  their  in- 
nervation.  Such  examples  as  this  can  be  recognized  in  a 
majority  of  cases. 

Pleurisy. — Disease  processes  in  the  lungs  produce 
spinal  lesions  of  various  kinds,  according  to  their  intensity 
and  destructiveness.  Pleurisy  produces  so  great  contrac- 
tion in  respiratory  muscles,  which  act  particularly  on  the 
ribs  lying  over  the  inflamed  area,  that  friction  of  the  pleural 
surfaces  at  this  point  is  reduced  to  a  minimum.  Physicians, 
taking  their  plan  from  this  natural  compensatory  contrac- 
tion, frequently  reinforce  natural  efforts  by  strapping  over 
the  contracted  area  with  adhesive.  The  thorax  adapts  itself 
to  the  state  of  its  contents,  hence  when  a  portion  of  the  lung 
is  destroyed  the  antero-posterior  diameter  of  the  chest  is  les- 
sened in  proportion.  The  vertebral  and  costo-vertebral  ar- 
ticulations enter  into  this  adaptive  process  and  hence  ex- 
hibit decided  lesion  phenomena. 

Cardiac  Lesion  Patterns. — In  case  of  heart  lesions  the, 
body  is  called  upon  to  make  extensive  compensatory  reac- 
tions and  hence  our  spiilal  lesion  phenomena  may  be  limited 
to  the  area  of  the  heart's  innervation,  or  extend  in  propor- 
tion as  the  heart's  condition  involves  the  pulmonary  circu- 
lation, the  portal  circulation  or  the  kidney. 

Unity  of  the  Body. — Disease  processes  in  the  pelvic  vis- 
cera produce  their  characteristic  spinal  lesion  phenomena 
just  as  the  thoracic  and  abdominal  organs.  The  point  we 
desire  to  emphasize  is  that  the  unity  of  the  body  is  exempli- 
fied by  the  spinal  lesion  phenomena.  No  organ  or  tissue 
can  or  does  suffer  injury  without  other  tissues  being  drafted 
to  compensate  for  its  condition  so  as  to  maintain  not  only 
existence  but  the  most  satisfactory  life  of  which  the  organ- 
ism is  capable.  If  the  spinal  lesion  is  viewed  not  only  as  a 
possible  cause  but,  also,  as  a  quite  probable  effect  of  tissue 
disturbance  elsewhere,  we  will  appreciate  more  fully  the 
manner  in  which  the  body  strives  to  live  up  to  its  best. 


PRINCIPLES  OF  OSTEOPATHY  59 


CHAPTER  IV. 

SPINAL  HYPERAESTHESIA  AND  MUSCULAR 
TENSION. 

Osteopaths  are  not  the  first  or  only  physicians  who 
have  used  the  spine  as  a  means  of  diagnosis  as  well  as  an 
area  upon  which  to  concentrate  therapeutic  methods.  It  is 
interesting  and  instructive  to  note  the  steps  in  the  develop- 
ment of  the  knowledge  of  spinal  conditions  and  of  the  indica- 
tions of  remote  functional  disturbances  which  are  registered 
there. 

Subjective  Symptoms. — Subjective  symptoms  precede 
any  attempt  to  discover  objective  evidences  of  disease.  It 
was  early  noted  by  physicians  that  patients  could  not  be  re- 
lied upon  to  interpret  their  own  symptoms.  This  led  to  ef- 
forts to  discover  symptoms  which  were  independent  of  the 
patient's  imperfect  perceptions.  Palpation  would  naturally 
be  used  at  the  areas  complained  of  by  the  patient.  Since 
the  brain  takes  cognizance  of  only  the  peripheral  areas  of 
distribution  of  sensory  nerves,  instead  of  the  whole  course 
of  the  nerve  fibers,  the  physician  might  still  be  misled  in  ap- 
plying palpation,  because  he  would  be  largely  governed  by 
the  patient's  sensory  impressions.  Palpation  made  with  ref- 
erence to  a  realizing  sense  of  the  distribution  and  function  of 
the  nervous  system,  becomes  a  more  satisfactory  means  of 
diagnosis.  As  the  knowledge  of  the  nervous  system  in- 
creased, attention  was  called  more  and  more  to  the  spinal 
column,  on  account  of  its  relations  to  the  great  nervous  mass 
within  it.  Palpation  of  the  spinal  column  demonstrated 
the  existence  of  sensitive  areas,  associated  with  visceral  or 
other  disorders ;  therefore,  hyperaesthetic  areas  are  the  first 


60  PRINCIPLES  OF  OSTEOPATHY 

diagnostic  points  mentioned  in  medical  literature,  in  regard 
to  the  spinal  lesion.  Such  hyperaesthetic  areas  were  con- 
sidered as  evidence  of  spinal  irritation ;  that  is,  irritation  of 
the  spinal  cord. 

Irritation  of  the  Spinal  Nerves. — The  first  reference 
to  spinal  irritation  which  I  have  found  is  contained  in  a 
monograph  entitled  "A  Treatise  on  Neuralgic  Diseases 
Dependent  on  Irritation  of  the  Spinal  Marrow  and  Ganglia 
of  the  Sympathetic  Xerve,"  by  Thomas  Pridgin  Teale,  1834. 
He  quotes  a  letter  from  Mr.  R.  P.  Player  to  the  editor  of 
the  Quarterly  Journal  of  Science  "On  Irritation  of  the 
Spinal  Xerves,"  dated  December  10,  1821,  as  follows:  "I 
take  the  liberty  to  submit  to  your  notice  a  pathological 
fact  which  has  not,  to  the  best  of  my  knowledge,  been 
generally  remarked  and  attention  to  which,  so  far  as  my 
own  experience  goes,  promises  some  diminution  of  those 
difficulties  with  which  the  healing  art  has  to  contend. 
Most  medical  practitioners  who  have  attended  to  the  sub- 
ject of  spinal  disease,  must  have  observed  that  its  symp- 
toms frequently  resemble  various  and  dissimilar  maladies 
and  that  commonly  every  function  of  every  organ  is  im- 
paired whose  nerves  originate  near  the  seat  of  the  disorder. 
The  occurrence  of  pain  in  distant  parts  forcibly  attracted 
my  attention  and  induced  frequent  examinations  of  the 
spinal  column  ;  and  after  some  years'  attention,  I  considered 
myself  enabled  to  state  that  in  a  great  number  of  diseases 
morbid  symptoms  may  be  discovered  about  the  origins  of  the 
nerves  which  proceed  to  the  affected  parts,  or  of  the  spinal 
branches  which  unite ;  and  that  if  the  spine  be  examined, 
more  or  less  pain  will  commonly  be  felt  by  the  patient  on 
the  application  of  pressure  about  or  between  those  verte- 
brae from  which  such  nerves  emerge. 

Spinal  Treatment. — "This  spinal  affection  may,  per- 
haps, be  considered  as  the  consequence  of  diseases,  but  of 
its  existence  at  their  commencement  any  one  may  satisfy 
himself;  and  this  circumstance,  combined  with  the  success 
which  has  attended  the  employment  of  topical  applications 


PRINCIPLES  OF  OSTEOPATHY  61 

to  the  tender  parts  about  the  vertebrae,  appears  to  indicate 
that  the  cause  may  exist  there.  Prejudice  sometimes  oper- 
ates against  ideas  of  connection  so  remote;  but  in  many 
instances  patients  are  surprised  at  the  discovery  of  tender- 
ness in  a  part,  of  whose  implication  and  disease  they  had 
not  the  least  suspicion." 

Control  of  the  Body  by  the  Nervous  System. — Dr. 
Teale  brings  to  his  aid  in  the  exposition  of  his  subject,  some 
interesting  corroboratory  observations  made  by  others  and 
recorded  in  the  medical  literature  of  that  period.  He  quotes 
Dr.  Darwell  in  an  interesting  paragraph  which  is  a  faint 
distant  undercurrent  of  Dr.  A.  T.  Still's  oft-repeated  state- 
ment concerning  the  interaction  of  nerves  and  the  blood 
stream.  The  passage  is  as  follows :  "If,  however,  the  nerv- 
ous system  is  more  or  less  connected  with  every  function 
of  the  animal  body ;  if  the  circulation  of  the  blood,  the  phe- 
nomena of  the  respiration  and  the  operation  of  intellect, 
cannot  be  carried  on  without  its  intervention,  the  manner 
in  which  it  is  disregarded  can  not  but  be  a  most  important 
defect.  It  has  perhaps  in  great  measure  arisen  from  always 
contemplating  the  brain  as  acted  upon  by  the  circulation 
and  never  reversing  the  order  of  review." 

A  Concept  of  the  Nervous  System. — One  of  the  best 
expressed  concepts  of  the  nervous  system  I  have  read,  is 
Dr.  Teale's  introduction  to  his  monograph.  It  is  the  con- 
cept which  is  being  more  clearly  taught  in  osteopathic  col- 
leges than  in  those  of  other  schools  of  medicine :  "The 
term  Neuralgia  which  was  originally  employed  to  designate 
certain  affections  of  nerves  attended  with  severe  pain  has 
of  late  with  great  propriety  been  extended  from  its  original 
and  literal  signification,  to  many  other  morbid  affections 
of  nerves,  which  are  not  characterized  by  pain,  but  by  some 
other  perverted  state  of  their  functions." 

Neuralgia. — "Neuralgia  includes  within  its  range  a  great 
variety  of  diseases,  presenting  an  endless  diversity  both  in 
their  symptoms  and  in  the  parts  where  they  are  seated. 
That  such  variety  should  exist,  ceases  to  excite  surprise, 


62  PRINCIPLES  OF  OSTEOPATHY 

when  we  consider  how  varied  are  the  functions  of  the  dif- 
ferent nerves  and  how  diversified  the  tissues  and  organs  to 
which  they  are  distributed. 

"To  the  attentive  observer  of  diseases,  neuralgic  affec- 
tions, under  the  more  extended  signification,  must  repeat- 
edly present  themselves.  The  skin,  for  instance,  may  be 
the  seat  of  every  degree  of  exalted  or  diminished  sensi- 
bility, from  the  slightest  uneasiness  to  the  most  acute  suf- 
fering and  from  the  most  trivial  diminution  of  sensibility 
to  the  complete  obliteration  of  feeling, — symptoms  not  de- 
pendent upon  disease  affecting  the  different  tissues  of  the 
part  but  solely  referable  to  a  morbid  condition  of  the  sen- 
tient nerves.  The  voluntary  muscles  may  in  like  manner 
indicate  in  a  variety  of  ways  a  morbid  condition  of  the 
nerves  with  which  they  are  supplied.  They  may  be  affected 
with  weakness,  spasms,  tremors,  or  a  variety  of  other  dis- 
ordered states  included  within  the  two  extremes  of  con- 
vulsion and  paralysis.  The  involuntary  muscles  may  have 
the  harmony  of  their  actions  interrupted  from  a  morbid 
condition  of  their  nerves;  the  heart  may  be  affected  with 
palpitation ;  the  vermicular  motion  of  the  stomach  or  the 
peristaltic  action  of  the  intestines  may  be  subject  to  irreg- 
ularity. The  sensibility  of  the  internal  organs  may  like- 
wise be  affected,  the  heart,  the  stomach,  the  intestines, 
being  the  seat  of  pain,  referable  to  their  nerves,  and  inde- 
pendent of  inflammation,  or  any  alteration  of  structure. 
The  secretions  may  also  undergo  alterations,  both  in  quan- 
tity and  quality,  from  a  perverted  agency  of  the  nerves 
upon  which  they  depend.  Such  is  a  very  imperfect  recital 
of  the  various  morbid  affections  which  may  be  included 
under  the  term  Neuralgia,  and  so  frequent  is  their  occur- 
rence that  they  must  be  familiar  to  every  practitioner.  They 
are,  however,  often  perplexing  in  their  treatment  and  not 
unfrequently  exhaust  the  patience  of  the  afflicted  sufferer, 
and  also  of  the  medical  attendant. 

"The  difficulty  and  embarrassment  which  have  attended 
the  diagnosis  and  treatment  of  these  affections,  I  am  in- 


PRINCIPLES  OF  OSTEOPATHY  63 

clined  to  believe,  has  principally  arisen  from  mistaken  views 
of  their  pathology.  They  have  too  often  been  regarded  as 
actual  diseases  of  those  nervous  filaments  which  are  the 
immediate  seat  of  the  neuralgia  instead  of  being  consid- 
ered as  symptomatic  of  disease  in  the  larger  nervous  masses 
from  which  those  filaments  are  derived ;  hence  the  treat- 
ment has  too  frequently  been  ineffectually  applied  to  the 
seat  of  neuralgia ;  instead  of  being  directed  to  the  more 
remote  and  less  obvious  seat  of  disease. 

"It  is  now  pretty  generally  admitted  as  a  pathological 
axiom,  that  disease  of  the  larger  nervous  masses,  as  the 
brain  and  spinal  marrow,  is  not  so  much  evinced  by  phe- 
nomena in  the  immediate  seat  of  disease,  as  in  those  more 
remote  parts  to  which  the  nerves  arising  from  the  diseased 
portion  are  distributed.  In  the  more  severe  forms  of  dis- 
ease, this  principle  is  readily  admitted  and  recognized. 
When  for  instance  one-half  of  the  body  shall  have  lost  its 
sensibility  and  the  corresponding  muscles  their  power  of 
action,  the  skin  and  the  muscles  are  not  regarded  as  the 
seat  of  disease,  but  the  brain  is  immediately  referred  to. 
In  the  slightest  forms  of  disease  of  the  brain  and  spinal 
marrow,  such  as  do  not  completely  obliterate  but  merely 
impair  or  pervert  the  functions  of  the  nerves — such  as  do 
not  paralyze  the  sentient  and  muscular  powers  of  the  part 
but  produce  weakness,  tremors,  spasms,  etc.,  in  the  mus- 
cular system,  and  numbness  and  prickings,  pains  and  other 
morbid  feelings  in  the  nerves  of  sensation,  this  important 
principle,  which  as  strictly  obtains  as  in  the  former  instance, 
is  too  often  entirely  overlooked;  and  a  numerous  class  of 
complaints  of  very  frequent  occurrence,  are  regarded  as 
nervous  or  spasmodic  diseases  of  the  part  affected,  instead 
of  being  considered  as  actual  diseases  of  that  portion  of 
the  brain  and  spinal  marrow  from  which  the  nerves  of  the 
part  are  derived. 

Visceral  Disturbance  Due  to  Disturbed  Nerve  Control. 
— "The  same  pathological  principle  is,  I  believe,  equally 
applicable  to  the  sympathetic  system  of  nerves;  although 


64  PRINCIPLES  OF  OSTEOPATHY 

it  may  be  difficult  to  establish  this  opinion  by  actual  ex- 
periment, yet  I  think  it  may  be  rested  upon  a  well  grounded 
analogy,  which  will  justify  us  in  regarding  the  nervous 
masses  of  the  ganglionic  system  as  bearing  the  same  rela- 
tion to  the  nerves  derived  from  them,  as  the  large  nervous 
masses  of  the  cerebro-spinal  system  bear  to  their  respective 
nerves.  I  fence  many  nervous  affections  of  the  viscera  ought 
not  be  considered  as  diseases  of  the  viscera  themselves  but 
as  symptomatic  of  disease  in  those  particular  ganglia 
whence  their  nerves  are  derived. 

Co-existence  of  Spinal  Tenderness.  —  "Influenced  by 
such  considerations,  I  have  for  a  few  years  been  in  the 
habit  of  treating  many  of  these  nervous  affections  as  dis- 
eases of  some  portion  of  the  spinal  marrow  or  ganglia;  and 
have  been  still  further  confirmed  in  my  opinion  by  the 
frequent  and  almost  uniform  co-existence  of  tenderness 
on  pressing  some  portion  of  the  vertebral  column  and  the 
circumstances  of  the  tender  portion  of  the  spine  being  in  a 
particular  situation  where  the  nerves  of  the  affected  part 
originate. 

Symptoms  of  Spinal  Irritation.  —  "The  symptoms  of 
spinal  irritation  consist  in  an  infinite  variety  of  morbid 
functions  of  the  nerves  of  sensation  and  volition  which 
have  their  origin  in  the  spinal  marrow,  and  the  parts  in 
which  these  morbid  functions  are  exhibited,  of  course,  bear 
reference  to  the  distribution  of  the  spinal  nerves. 

"The  morbid  states  of  sensation  include  every  variety, 
from  the  slightest  deviation  from  the  healthy  sensibility  of 
any  part,  to  the  most  painful  neuralgic  affections  on  the 
one  hand,  and  to  complete  numbness  or  loss  of  feeling  on 
the  other;  including  pains  which  may  be  fixed  or  fugitive 
or  darting  in  the  direction  of  the  nerve,  pricking  and  ting- 
ling sensations,  a  sense  of  creeping  in  the  skin,  of  cold 
water  trickling  over  it,  and  numerous  other  states  of  per- 
verted sensation  of  which  words  are  inadequate  to  convey 
a  description.  In  the  muscular  system  we  find  weakness 


PRINCIPLES  OF  OSTEOPATHY  65 

or  loss  of  power,  tremors,  spasms  or  cramps  and  sometimes 
a  tendency  to  rigidity. 

"These  symptoms  sometimes  exist  in  so  slight  a  degree 
that  the  patient  considers  them  unworthy  of  notice,  and 
only  admits  their  existence  when  particular  inquiry  is  made 
respecting  them ;  the  only  complaint  which  he  makes  be- 
ing of  an  unaccountable  sense  of  weakness  and  inability 
of  exertion.  In  other  cases  the  tremors  have  excited  alarm ; 
sometimes  the  neuralgic  pains  in  the  scalp  or  the  fixed 
pain  in  the  muscles,  particularly  when  it  occurs  in  the  in- 
tercostal muscles,  have  suggested  the  idea  of  serious  disease 
in  the  brain  or  in  the  lungs;  and  when  the  pain  is  seated 
in  the  muscles  of  the  abdomen,  a  fear  that  some  organic 
disease  of  the  abdominal  viscera  has  taken  place  harasses 
the  mind  of  the  patient.  The  muscular  weakness  in  some 
cases  tending  to  paralysis  often  suggests  the  fear  of  apoplexy 
or  paralysis  from  cerebral  disease. 

Duration  of  Affections  Due  to  Spinal  Irritation. — "The 
affection  is  often  of  very  protracted  duration,  undergoing 
alternate  variations  from  the  sanative  powers  of  the  con- 
stitution and  the  different  existing  causes  of  disease.  There 
are  many  individuals  in  whom  the  complaint  has  existed, 
in  varying  degrees  of  intensity  for  a  series  of  years,  with- 
out its  real  nature  having  been  suspected;  the  patients  and 
their  medical  attendants  having  regarded  it  throughout  as 
a  rheumatic  or  a  nervous  affection. 

"In  this  complaint  tenderness  in  the  portion  of  the 
vertebral  column  which  corresponds  to  the  origin  of  the 
affected  nerves,  is  generally  in  a  striking  and  unequivocal 
manner  evinced  by  pressure.  In  some  instances  the  ten- 
derness is  so  great  that  even  slight  pressure  can  scarcely 
be  borne,  and  will  often  cause  pain  to  strike  from  the  spine 
to  the  seat  of  spasm  or  neuralgia. 

"This  affection  of  the  spinal  marrow  occasionally  exists 
throughout  its  whole  extent;  more  frequently,  however,  it 
is  confined  to  some  particular  portion,  and  .occasionally  is 
seated  in  different  and  remote  portions  at  the  same  time; 


66  PRINCIPLES  OF  OSTEOPATHY 

the  particular  symptoms  and  tenderness  on  pressure  indi- 
cating the  affected  part. 

"The  symptoms  of  course  vary  considerably,  according 
to  the  particular  part  of  the  spine  which  is  affected,  and 
bear  reference  to  the  distribution  of  the  different  spinal 
nerves. 

Affections  of  the  Upper  Cervical  Region. — "When  the 
upper  cervical  portion  of  the  spinal  marrow  is  diseased,  we 
frequently  find  neuralgic  affections  of  the  scalp;  the  pain 
strikes  in  various  directions  over  the  posterior  and  lateral 
parts  of  the  head ;  sometimes  the  twigs  in  the  neighborhood 
of  the  ear,  sometimes  those  which  ascend  over  the  occiput 
to  the  superior  part  of  the  scalp,  are  more  particularly  the 
seat  of  the  complaint;  the  nervous  twigs  distributed  to  the 
integuments  of  the  neck  are  occasionally  affected,  the  pain 
darting  across  the  neck  to  the  edge  of  the  lower  jaw,  and 
sometimes  encroaching  a  little  upon  the  face.  These  neu- 
ralgic diseases  frequently  assume  an  intermittent  form,  the 
paroxysms  generally  occurring  in  the  evening.  A  stiff  neck 
or  impaired  action  of  the  muscles  moving  the  head  fre- 
quently attend  the  affection  of  the  upper  cervical  portion 
of  the  spinal  marrow ;  and  occasionally  the  voice  is  com- 
pletely lost,  or  suffers  alteration,  and  the  act  of  speaking  is 
attended  with  pain  or  difficulty. 

Irritation  of  the  Lower  Cervical  Region. — "Irritation 
of  the  lower  cervical  portion  of  the  spinal  marrow  gives  rise 
to  a  morbid  state  of  the  nerves  of  the  upper  extremities, 
shoulders,  and  integuments  at  the  upper  part  of  the  thorax. 
Pains  are  felt  in  various  parts  of  the  arm,  shoulder,  and 
breast ;  sometimes  the  pain  takes  the  course  of  the  anterior 
thoracic  branches  of  the  brachial  plexus,  occasionally  the 
pain  is  fixed  at  some  point  near  the  clavicle,  scapula  or 
shoulder  joint  at  the  insertion  of  the  deltoid,  or  near 
the  elbow  or  shoots  along  the  course  of  some  of  the  cutan- 
eous nerves.  Frequently  one  or  both  of  the  mammae  be- 
come exquisitely  sensible  and  painful  on  pressure,  and 
some  degree  of  swelling  occasionally  takes  place  in  the 


67 

breast,  attended  with  a  knotty  and  irregular  feeling,  when 
the  neuralgic  pains  have  existed  a  considerable  time  in 
that  part,  prickling  and  numbness,  tingling  and  creeping 
sensations  are  often  felt  in  the  upper  extremities;  and 
also  a  sensation  of  cold  water  trickling  over  the  surface. 
On  rubbing  the  hands  over  the  part  affected  a  soreness  is 
frequently  felt,  which  is  described  as  not  merely  situated 
in  the  integuments  but  also  in  the  more  deep  seated  parts. 
In  the  muscular  system  are  observed  most  frequently  a 
weakness  of  the  upper  extremities  sometimes  referred  par- 
ticularly to  the  wrists,  tremors  and  unsteadiness  of  the 
hands ;  also  cramps  and  spasms  of  various  degrees  of  in- 
tensity. Occasionally  there  is  an  inability  to  perform  com- 
plete extension  of  the  elbows,  the  arm  appearing  restrained 
by  the  tendon  of  the  biceps;  and  tightness  being  produced 
in  this  part  when  extension  is  attempted  beyond  a  certain 
point.  As  far  as  I  have  observed,  the  pain  and  other  mor- 
bid feelings  in  the  upper  extremities  and  chest  are  felt 
more  frequently  and  more  severely  on  the  left  than  on  the 
right  side. 

"Females  of  sedentary  habits  appear  particularly  sub- 
ject to  these  affections  of  the  upper  extremities,  and  it  is 
not  uncommon  for  them  to  complain  of  being  scarcely  able 
to  feel  the  needle  when  it  is  held  in  their  fingers,  and  that 
their  needles  and  work  frequently  drop  from  their  hands. 

Irritation  in  the  Upper  Dorsal  Region. — "When  the 
upper  dorsal  portion  is  affected,  in  addition  to  various  mor- 
bid sensations  similar  to  those  in  the  extremities,  there  is 
often  a  fixed  pain  in  some  part  of  the  intercostal  muscles, 
to  which  the  name  pleurodynia  has  been  assigned ;  and  when 
this  pain  has  existed  a  long  time,  there  is  tenderness  on 
pressing  the  part. 

Irritation  in  the  Lower  Dorsal  Region. — "When  the 
lower  dorsal  half  of  the  spinal  marrow  is  the  seat  of  irri- 
tation, or  subacute  inflammation,  the  pleurodynia,  when  it 
exists,  is  felt  in  the  lower  intercostal  muscles;  frequently 
there  is  also  a  sensation  of  a  cord  tied  round  the  waist;  and 


68  PRINCIPLES  OF  OSTEOPATHY 

oppressive  sense  of  tightness  across  the  epigastrium  and 
lower  sternal  region  ;  and  soreness  along  the  cartilages  of 
the  lower  ribs  or  in  the  course  of  insertion  of  the  diaphragm. 
Various  pains,  fixed  and  fugitive,  are  also  felt  in  the  par- 
ietes  of  the  abdomen,  throughout  any  part  of  the  abdom- 
inal and  lumbar  muscles ;  the  pain  is  frequently  fixed  in 
some  portion  of  the  rcctus  muscle  and  not  infrequently  in 
the  oblique  muscle  or  transversalis,  a  little  above  the  crest 
of  the  ilium,  particularly  when  the  origin  of  two  or  three 
of  the  lowest  dorsal  nerves  is  diseased. 

Irritation  in  the  Lumbar  and  Sacral  Regions. — "The 
affection  of  the  lumbar  and  sacral  portion  of  the  spinal  cord 
often  produces  a  sensation  of  soreness  in  the  scrotum  and 
neighboring  integuments;  and  the  lower  extremities  be- 
come the  seat  of  various  morbid  sensations,  spasms,  tremors, 
etc.,  for  the  most  part  resembling  those  which  have  been 
described  as  occurring  in  the  upper  limbs.  The  patients 
also  complain  of  a  sense  of  insecurity  or  instability  in 
walking;  their  knees  totter,  and  feel  scarcely  able  to  sup- 
port the  weight  of  the  body. 

The  Effect  of  Recumbency. — "In  some  cases  very  con- 
siderable relief  is  found  from  recumbency,  the  pain  fre- 
quently being  diminished  as  soon  as  the  patient  retires  to 
bed,  independently  of  any  paroxysmal  remission. 

Irritation  of  Spinal  Marrow  Not  Necessarily  Dependent 
on  Disease  of  Vertebrae. — "This  irritation  or  subacute  in- 
flammatory state  of  the  spinal  marrow  is  not  necessarily 
connected  with  any  deformity  of  the  spine,  or  disease  in 
the  vertebrae.  It  may  co-exist  with  these  as  well  as  with 
any  other  diseases,  but  it  so  repeatedly  occurs  without  them 
that  they  can  not  be  regarded  as  dependent  upon  each 
other.  Where,  however,  inflammation  and  ulceration  of 
the  vertebrae  or  intervertebral  cartilages  exist,  it  is  prob- 
able they  may  predispose  to,  and  in  some  instances,  act 
as  an  exciting  cause  of  an  inflammatory  state  of  the  nervous 
structures  which  they  contain ;  for  we  not  frequently  find 
inflammatory  affections  of  the  vertebrae  in  conjunction  with 


PRINCIPLES  OF  OSTEOPATHY  69 

symptoms  of  irritation  of  the  spinal  marrow.  But  these  two 
affections,  although  co-existing,  bear  no  regular  relations 
to  each  other;  and  during  the  progress  of  the  vertebral 
disease  the  affection  of  the  nervous  structures  is  subject  to 
great  changes  and  fluctuations.  The  local  remedies  em- 
ployed for  arresting  the  disease  in  the  bone  often  alleviate 
the  affection  of  the  spinal  marrow  at  the  very  commence- 
ment of  the  treatment,  long  before  the  vertebral  disease 
is  suspended ;  but  as  the  neighboring  inflammation  in  the 
bones  appears  to  predispose  or  excite  the  nervous  mass 
which  they  contain  to  disease,  relapses  of  the  nervous  af- 
fections are  repeatedly  occurring  during  the  whole  course 
of  the  complaint. 

Lateral  Curvature.  —  "The  affections  of  the  spine, 
termed  lateral  curvature  and  excurvation,  appear  to  have 
no  necessary  connection  with  the  disease  which  I  have 
been  describing;  and  the  proportion  of  cases  in  which  they 
are  found  united  is  so  small  that  lateral  curvature  can 
scarcely  be  considered  even  as  predisposing  to  this  disease. 
The  most  extreme  degrees  of  deformity  are  frequently  ob- 
served without  any  affection  of  the  nerves;  and  when 
lateral  curvature  does  occasionally  co-exist,  local  antiflo- 
gistic  treatment  will  often  speedily  remove  fhe  nervous 
symptoms  while  the  curvature  remains  unrelieved.  Hence 
there  is  an  impropriety  in  considering  these  nervous  symp- 
toms as  a  result  of  the  deformity  and  in  explaining  them 
upon  the  mechanical  principle  of  pressure  and  stretching, 
to  which  the  nerves  are  supposed  to  be  subjected  as  they 
issue  from  the  intervertebral  foramina.  If  the  pressure 
and  stretching  produced  by  the  curvature  were  the  cause 
of  the  nervous  symptoms,  they  ought  to  continue  as  long 
as  the  deformity  remains. 

Treatment. — "When  the  different  neuralgic  symptoms 
which  have  been  enumerated  can  be  traced  to  this  morbid 
state  of  some  portion  of  the  spinal  marrow,  the  treatment 
that  ought  to  be  pursued  is  readily  decided  upon.  Local 
depletion  by  leeches  or  cuping,  and  counter  irritation  by 


70  PRINCIPLES  OF  OSTEOPATHY 

blisters  to  the  affected  portion  of  the  spine,  are  the  prin- 
cipal remedies.  A  great  number  of  the  cases  will  fre- 
quently yield  to  the  single  application  of  any  of  these 
means.  Some  cases  which  have  even  existed  several  months 
I  have  seen  perfectly  relieved  by  the  single  application  of 
a  blister  to  the  spine,  although  the  local  pains  have  been 
ineffectually  treated  by  a  variety  of  remedies  for  a  great 
length  of  time.  A  repetition  of  the  local  depletion  and 
blistering  is,  however,  often  necessary  after  the  lapse  of  a 
few  days,  and  sometimes  is  required  at  intervals  for  a  con- 
siderable length  of  time.  In  a  few  very  obstinate  cases 
issues  or  setons  have  been  thought  necessary;  and  where 
the  disease  has  been  very  unyielding,  a  mild  mercurial 
course  has  appeared  beneficial. 

"When  my  attention  was  first  directed  to  this  subject, 
I  considered  recumbency  a  necessary  part  of  the  treatment; 
it  is,  for  a  moderate  length  of  time,  undoubtedly  beneficial 
and  frequently  very  much  accelerates  recovery,  but  sub- 
sequent observation  has  convinced  me  that  it  is  by  no 
means  essential.  I  have  seen  several  instances  of  the  most 
severe  forms  of  those  complaints  occurring  in  the  poorer 
classes  of  society,  where  continued  recumbency  was  im- 
practicable, which  have,  nevertheless,  yielded  without  dif- 
ficulty to  the  other  means  of  the  treatment,  whilst  the  indi- 
viduals were  pursuing  their  laborious  avocations. 

"These  observations,  howefver,  are  not  intended  to 
apply  to  those  cases  in  which  there  is  actual  disease  of  the 
vertebrae. 

"When  there  exists  a  tendency  to  relapse,  I  have 
thought  it  advantageous  to  continue  the  use  of  some  stim- 
ulating liniment  to  the  spine  for  a  few  weeks  after  the 
other  means  of  treatment  have  been  discontinued.  A  lini- 
ment consisting  of  one  part  spirits  of  turpentine  and  two 
of  olive  oil  is  what  has  generally  been  employed. 

Ganglia  of  the  Sympathetic  Nerves. — "The  ganglia  of 
the  sympathetic  nerves  appear  subject  to  a  state  of  disease 


PRINCIPLES  OF  OSTEOPATHY  71 

similar  to  that  which  has  been  described  in  the  preceding 
chapter,  as  occurring-  in  the  spinal  marrow. 

"As  the  disease  may  be  confined  to  one  part  of  the 
spinal  marrow,  or  exist  simultaneously  in  "different  por- 
tions, or  may  even  pervade  its  whole  extent,  so  the  af- 
fection of  ganglia  may  be  confined  to  one  of  these  nervous 
masses,  may  exist  in  several  which  are  contiguous,  or  in 
ganglia  remote  from  each  other;  and  as  there  is  reason  to 
believe  the  whole  chain  may  occasionally  be  affected. 

"The  disease  of  the  ganglia  is  seldom  found,  except  in 
conjunction  with  that  of  the  corresponding  portion  of  the 
spinal  marrow,  whereas  the  spinal  marrow  is  often  affected 
without  the  neighboring  ganglia  being  under  the  influence 
of  disease.  Thus  we  frequently  find  symptoms  of  disease 
in  a  portion  of  the  spinal  marrow  without  any  evidence 
of  its  existence  in  the  corresponding  ganglia,  frequently  the 
symptoms  of  both  combined,  and  occasionally,  but  rarely, 
symptoms  referable  to  the  ganglia  without  the  spinal  mar- 
row being  implicated. 

Symptoms  of  Irritation  of  Sympathetic  Ganglia. — "The 
principal  symptoms  resulting  from  irritation  of  the  ganglia 
of  the  sympathetic  are  to  be  found  in  those  organs  which 
derive  their  nerves  from  this  source.  They  consist  of  per- 
verted functions  of  these  organs,  and  are  exemplified  by  a 
variety  of  phenomena.  The  involuntary  muscles,  deriving 
their  power  from  the  sympathetic  have  their  action  altered 
as  is  evinced  by  spasms  and  irregularity  in  their  contrac- 
tions. The  heart  is  seized  with  palpitations,  the  large  ves- 
sels with  inordinate  pulsations;  the  muscular  fibers  con- 
necting with  the  bronchial  apparatus  are  thrown  into 
spasms,  constituting  a  genuine  asthma  independent  of 
bronchial  inflammation.  The  muscular  fibers  of  the  stom- 
ach and  intestines  become  the  seat  of  spasms  and  various 
other  deviations  from  their  natural  operation.  The  sensi- 
bility of  the  organs,  which  derive  their  sentient  power  from 
the  great  sympathetic,  is  variously  perverted,  the  nervous 
filaments  being  the  seat  of  pain.  The  heart  and  lungs,  for 


72  PRINCIPLES  OF  OSTEOPATHY 

instance,  are  subject  to  morbid  sensations  bearing  great 
analogy  to  those  which  have  been  designated  'tic  doulou- 
reaux'  when  occurring  in  the  spinal  nerves.  The  stomach 
and  intestines  are  liable  to  similar  neuralgia,  to  which  the 
names  gastrodynia  and  enterodynia  have  been  applied.  The 
kidneys,  the  bladder,  and  the  uterus  are  liable  to  the  same 
perverted  state  of  their  sensibility.  The  secretions  also 
undergo  alterations,  products  being  formed,  which  in  health 
have  no  existence.  This  is  exemplified  by  the  enormous 
secretions  of  air  which  sometimes  occur  in  the  stomach. 
Large  quantities  of  clear  transparent  liquid  are  also  secreted 
by  this  organ,  constituting  what  is  called  pyrosis.  The 
secretions  of  the  stomach  undergo  variation  in  their  quan- 
tities, rendering  them  unfit  for  digestive  process.  It  is 
probable  that  the  secretion  of  the  liver  also  experiences 
some  alteration  in  these  complaints.  The  urine  is  some- 
times influenced,  and  I  am  inclined  to  suspect  that  some 
forms  of  diabetes  partake  of  neuralgic  character.  Leu- 
corrhoea  is  frequently  a  concomitant  of  these  diseases,  and 
ceases  on  their  removal ;  but  I  am  not  prepared  to  say  that 
it  is  ever  symptomatic  of  them.  Irregularities  in  the  cata- 
menia  are  often  observed,  the  discharge  often  being  gen- 
erally in  excess. 

Middle  and  Lower  Thoracic  Sympathetic  Ganglia. — 
"The  ganglia  most  liable  to  the  disease  are  the  middle  and 
lower  thoracic,  from  which  the  splanchnic  nerves  are  de- 
rived, giving  rise  to  various  disorders  of  the  stomach  and 
digestive  organs,  which  will  hereafter  be  more  fully  dis- 
cussed. Next  in  frequency  is  the  affection  of  the  cervical 
ganglia,  producing  painful  and  spasmodic  states  of  the 
heart.  The  symptoms  denoting  disease  of  other  ganglia,  al- 
though occasionally  met  with,  are  less  frequent  in  their 
occurrence.  Irritability  of  temper  and  depression  of  spirits 
often  attend  these  complaints,  particularly  when  the  stom- 
ach is  the  part  which  suffers. 

"The  disease  of  the  ganglia,  like  that  of  the  spinal 
marrow,  is  not  necessarily  connected  with  disease  of  the 


PRINCIPLES  OF  OSTEOPATHY  73 

vertebrae  or  distortion  of  the  spine.  It  may  co-exist  with 
these  complaints,  and,  when  it  does  so,  the  symptoms 
proper  to  the  ganglionic  disease  are  often  erroneously  sup- 
posed to  be  produced  by  distortion  or  by  disease  of  the 
vertebrae;  they  are,  however,  frequently  relieved  by  treat- 
ment, whilst  the  disease  of  the  bones  remains  uninfluenced 
by  it,  and  the  most  extreme  distortion  of  the  spine  or  de- 
struction of  the  vertebrae  from  inflammation  may  exist 
without  there  being  any  symptom^  attributable  to  neuralgia 
of  the  sympathetic  nerves. 

"In  conjunction  with  the  symptoms  denoting  disease 
of  the  ganglia,  tenderness  to  a  greater  or  less  degree  may 
generally  be  found  on  pressing  some  part  of  the  spine,  and 
the  tender  portion  invariably  corresponds  with  the  symp- 
toms; or  rather,  the  seat  of  tenderness  is  near  the  part 
occupied  by  the  particular  ganglia  from  which  the  nerves 
of  the  disordered  organ  are  derived ;  for  example,  when  the 
heart  is  affected  the  tenderness  is  found  in  some  of  the 
cervical  vertebrae,  and  when  the  stomach  is  the  seat  of 
complaint,  it  is  in  some  of  the  middle  or  lower  dorsal  ver- 
tebrae. 

Spinal  Treatment.  Hyperaemia. — "With  respect  to  the 
treatment,  I  have  but  little  to  add  to  what  has  been  said 
in  the  preceding  chapter  respecting  the  treatment  of  irrita- 
tion of  the  spinal  marrow.  Leeches,  cuping,  blisters,  etc., 
to  the  neighborhood  of  the  affected  ganglia  constitute  the 
essential  part." 

Muscular  Tension. — Following  the  observation  of  spinal 
tenderness  came  the  noting  of  muscular  tension  accompany- 
ing it.  As  near  as  I  can  determine  from  perusing  medical 
literature,  muscular  tension  was  not  recognized  until  after 
the  advent  of  Osteopathy.  Since  the  attention  of  medical 
writers  was  called  to  the  conditions  of  the  spinal  column 
called  "lesions"  there  are  frequent  passages  descriptive  of 
these  in  medical  literature.  One  of  the  best  of  these  ref- 
erences is  found  in  Boardmen  Reed's  work  on  "Diseases 
of  the  Stomach  and  Intestines,"  and  is  as  follows: 


74  PRINCIPLES  OF  OSTEOPATHY 

"Dr.  John  P.  Arnold  has  recently  called  attention  to 
a  novel  objective  sign  which  may  be  recognized  upon  pal- 
pation over  the  sensitive  regions  along  side  of  the  spinal 
vertebrae,  and  sometimes  in  such  regions  which  are  not 
sensitive  to  pressure,  though  in  all  cases  he  maintains  that 
the  part  of  the  body  supplied  by  the  vaso  motor  nerve 
fibres  immerging  in  the  corresponding  intervertebral  space 
will  be  found  to  present  some  abnormal  condition.  The 
peculiarity  described  by  him  is,  in  such  cases,  a  somewhat 
doughy,  and  in  chronic  ones,  a  gristly  tense,  cord-like  feel- 
ing of  the  band  of  longitudinal  muscular  fibres  which  run 
up  and  down  on  either  side  of  the  spine.  This  abnormality 
is  supposed  by  Arnold  to  be  due  to  a  congested  or  infiltrated 
condition  of  the  muscle  while  the  cord  itself  is  anaemic, 
probably  in  chronic  cases.  Hammond  believed  the  spinal 
cord  to  be  anaemic  in  such  cases.  The  findings  obtained  by 
a  careful  palpation  over  the  spine  should  thus  assist  in  di- 
recting our  attention  to  the  organ  or  part  of  the  body  which 
may  be  suspected  of  being  diseased. 

Digital  Examination  of  the  Spinal  Area. — "You  should 
make  it  a  rule  to  examine  carefully  the  spines  of  all  chronic 
invalids  by  pressing  deeply  with  the  finger  tips  (or  with 
the  thumbs,  as  Flint  advised)  close  to  the  vertebrae  and 
then  exert  gentle  traction  in  a  lateral  direction  outward 
from  the  spine  on  either  side.  The  patient  should  be  lying 
upon  his  right  side  while  you  palpate  along  the  left  side  of 
the  vertebrae,  and  should  then  change  to  his  left  side  in 
order  that  you  may  palpate  upon  the  right  side  of  the 
latter  so  that  the  tissues  may  be  in  the  utmost  condition 
of  relaxation  practicable.  In  both  cases  you  will  find  it 
best  to  stand  in  front  of  the  patient  and  reach  over  his 
upper  side  to  make  palpation  along  the  region  of  the  upper 
side  of  the  spinal  column. 

"In  numerous  patients,  especially  those  suffering  from 
digestive  derangements,  you  will  be  likely  while  palpating 
in  the  way  described  to  recognize  in  the  longitudinal  muscles 
running  parallel  and  close  to  the  spine  the  tense,  cord-like 


PRINCIPLES  OF  OSTEOPATHY  75 

sensation  above  mentioned.  If,  simultaneously  with  your 
recognition  of  such  a  condition  the  patient  complains  of 
sensitiveness  in  the  same  regions,  the  accuracy  of  your 
finding  will  be  at  once  confirmed." 

The  Use  of  Spinal  Muscular  Tension  in  Diagnosis. — 
The  use  of  these  tense  cord-like  muscles  as  diagnostic  evi- 
dences of  disease  has  been  a  constant  practice  of  Osteo- 
paths from  the  beginning  of  Dr.  Still's  work.  Judging  from 
the  quotation  the  true  significance  of  these  contractions  has 
not  been  apprehended  by  the  medical  profession  in  general. 
It  is  very  evident  that  a  contracted  muscle  is  shorter  and 
thicker  than  when  relaxed,  also  that  when  contracted  it 
exerts  force  to  draw  its  extremities  together.  The  ends  of 
the  muscle  being  attached  to  bones  forming  portions  of 
a  movable  articulation,  a  change  in  the  relation  of  the 
bones  must  follow.  This  change  is  called  a  subluxation 
and  is  described  more  in  detail  in  another  chapter. 

Cause  or  Effect? — Having  noted  that  sensitiveness  and 
muscular  contraction  are  well  recognized  conditions  found 
along  the  spinal  column,  the  question  arises,  are  these 
merely  objective  symptoms  of  disease  or  are  they  to  a 
large  extent  causative  factors  in  the  origin  and  maintenance 
of  diseased  conditions  of  the  areas  of  peripheral  distribu- 
tion of  spinal  nerves?  Are  they  causes  or  effects? 

They  have  been  noted  almost  exclusively  as  efficient 
causes  of  disease.  Furthermore,  osteopathic  therapeutics 
have  been  administered  from  that  standpoint  with  marked 
success.  This  change  in  position  and  size  of  tissues  is 
recognized  as  an  obstruction  to  the  movements  of  fluids, 
and  therefore  is  a  condition  operating  in  the  system  to 
cause  disease. 


76  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  V. 

THE  SEGMENTATION  OF  THE  BODY. 

The  Lesion  as  a  Guide  in  Diagnosis. — Since  the  spinal 
lesion  may  be  either  cause  or  effect,  i.  e.,  a  trauma  or  an  ex- 
pression of  the  body's  protective  reaction,  we  need  certain 
fundamental  facts  upon  which  to  base  judgment.  No  mat- 
ter whether  the  lesion  is  cause  or  effect  the  physician  must 
recognize  it  as  a  guide  for  the  unravelling  of  a  series  of  phe- 
nomena which  are  quite  sure  to  be  present  in  any  case.  It  is 
a  well  recognized  fact  that  effects  become  causes  and  thus  a 
cycle  of  reflexes  become  established  making  it  difficult  to 
recognize  where  the  series  began.  Any  diagnosis  worthy 
the  name  must  be  based  on  structure  and  function.  Much  of 
the  phenomena  we  are  called  upon  to  interpret  is  difficult  to 
understand,  unless  we  know  not  only  normal  structure  but 
the  development  processes  whereby  this  present  structural 
formation  was  achieved. 

The  Spinal  Segment. — The  far  reaching  influence  of  a 
cervical  lesion  can  readily  be  understood  when  we  study  the 
embryological  development  of  cervical  structures.  To  men- 
tion a  nerve  to  a  diagnostician  should  instantly  bring  to  his 
mind  all  the  structural  associations  of  that  nerve,  its  origin 
and  distribution.  The  thought  of  its  origin  and  distribution 
would  naturally  bring  to  mind  an  association  of  all  the  tis- 
sues depending  on  it  for  innervation.  We  would  thus  have 
a  picture  of  a  localized  community  of  interests.  Considering 
the  similar  distribution  on  the  opposite  side  of  the  body  we 
have  pictured  a  sort  of  transverse  division  of  the  body. 
Every  pair  of  spinal  nerves,  with  the  tissues  directly  under 
their  influence,  should  form  in  our  minds  an  entity,  a  mech- 


PRINCIPLES  OF  OSTEOPATHY 


77 


anism  in  which  reactions  tend  to  take  place  independent  of 
all  other  segments.  Although  we  may  think  of  a  segment  as 
a  unit,  the  development  of  the  body  has  coalesced  its  various 
structures  in  such  a  way  as  to  locate  the  nervous  control  of 
any  one  structure,  such  as  a  muscle,  in  more  than  one  seg- 
ment of  the  spinal  cord,  hence  the  controlling  nerve  to  a 
muscle  usually  contains  fibers  from  more  than  one  segment. 


Lost 

cepholic  myotomes 


First  three 

cephoik 

myotoiws 


Ceroicol 

z.  ''••  •••••mA        myotomes 


Caudol  myotomcs 


Socrol  myotomes 


FIG  2  Scheme  to  illustrate  the  disposition  of  the  myotomes  in  the 
embryo  in  relation  to  the  head,  trunk  and  limbs.  Drawn  by  John 
Comstock  (after  Cunningham). 


78 


PRINCIPLES  OF  OSTEOPATHY 


It  is  readily  seen  that  there  is  an  element  of  protection  in 
this  fact.  A  slight  central  lesion,  i.  e.,  an  injury  to  the  spinal 
cord,  its  membranes ;  or  a  pressure  lesion  due  to  disease  of 
the  bone,  as  in  Pott's  disease,  might  not  produce  complete 
loss  of  function  in  any  single  muscle  because  the  governing 
nerve  to  that  muscle  is  made  up  of  fibers  from  two  or  more 
cord  segments. 

Injury  of  a  Single  Nerve.  Example :  Posterior  Thoracic. 
— Complete  paralysis  of  a  single  muscle  is  indicative  of 
serious  injury  to  its  governing  nerve  at  some  point  exterior 


•.Vptuni  U'lirtvn  iloi-Mil  tind 
'  ill  tnink  musculature. 

Nmv  l">  limb 

of  limb  nuisculaiun 

\»i<il  hlnstriiiii 


FIG.  3.     Diagram   of  a    segment  of  the  body   and   limb.     Drawn  by  John 
Comstoek    (after   Kolhnann). 

to  the  central  nervous  system ;  in  fact,  beyond  the  point  of 
coalescence  of  the  fibers  which  form  it.  As  an  example  of  in- 
jury of  a  single  nerve  we  may  take  a  case  of  paralysis  of  the 
Serratus  Magnus.  This  large  muscle  which  acts  to  hold  the 
posterior  border  of  the  scapula  close  to  the  thorax,  when  one 
is  pushing  with  the  hand  or  when  taking  a  deep  inspiration, 
is  innervated  by  the  posterior  thoracic  nerve  which  is  made 
up  of  fibers  from  the  upper  portion  of  the  brachial  plexus, 


PRINCIPLES  OF  OSTEOPATHY 


79 


fifth,  sixth  and  seventh  cervicals.  Evidently  an  injury  capa- 
ble of  involving  all  the  fibers  of  the  posterior  thoracic  nerve 
and  no  others  must  be  peripheral  to  the  point  of  junction  of 
its  fibers  from  the  fifth,  sixth  and  seventh  cervicals. 

A  patient  came  to  me  in  1901  complaining  of  a  peculiar 
loss  of  power  of  the  right  arm.    He  was  a  large,  powerfully 


FIG.  4.  Paralysis  of  right  serratus  magnus.  Shows  the  promi- 
nence of  the  scapula,  when  it  is  the  foundation  for  a  move- 
ment such  as  extension  of  the  arm  to  the  side. 

built  young  man  whose  occupation,  as  a  lumber  shover,  un- 
loading lumber  on  the  San  Pedro  docks,  was  lost  as  a  result 
of  his  condition.  He  gave  a  history  of  perfect  health  at  all 
times.  Said  that  two  days  previous,  on  Sunday,  he  had 
erected  a  tent  for  himself  and  as  he  was  tightening  the  guy 
ropes  he  felt  a  sharp  pain  under  his  right  shoulder  blade, 


80 


PRINCIPLES  OF  OSTEOPATHY 


which  was  immediately  followed  by  inability  to  push  with 
the  right  arm.  The  pain  was  of  short  duration.  He  de- 
scribed his  position  as  a  somewhat  awkward  one.  i.  e.,  he 
was  kneeling  on  his  right  knee  facing  one  of  the  tent  guy 
rope  pegs.  \Yith  his  right  hand  grasping  the  wooden  clamp 


FIG.    5.     Paralysis    of    right    serratus    magnus.       Shows    loss    of 
power  to  rotate  the  scapula  on  the  thorax. 


on  the  guy  rope,  he  attempted  to  draw  the  guy  rope  taut. 
His  great  strength  enabled  him  to  do  this,  even  though  his 
right  hand  was  considerably  behind  him.  Figs.  4  and  5 
show  the  effects  of  the  paralysis  of  the  Serratus  Magnus  in 
this  case. 

A  second  case  presenting  exactly  the  same  symptoms 
was  seen  in  the  clinic  of  the  Pacific  College  of  Osteopathy 


PRINCIPLES  OF  OSTEOPATHY  81 

a  short  time  later.  A  telephone  lineman,  while  engaged  in 
stringing  wire  from  pole  to  pole,  made  a  vigorous  awkward 
pull  with  the  right  hand  some  distance  back  of  his  hip.  His 
legs  were  entwined  about  the  crosspieces  of  the  pole.  At 
the  time  of  greatest  effort  he  felt  a  severe  pain  under  the 


FIG.  6.  Paralysis  of  right  serratus 
magnus.  Shows  the  "winged" 
condition  of  right  scapula  when 
arm  is  extended  forward. 

right  shoulder,  followed  by  a  profound  sense  of  weakness  in 
the  shoulder  and  arm.  The  scapula  immediately  took  a 
wing  position  and  the  patient  could  not  shove  with  the  right 
arm. 

These  cases  serve  to  give  us  a  picture  of  the  influence 
of  position  and  motion  of  the  shoulder  as  governed  by  one 


82  PRINCIPLES  OF  OSTEOPATHY 

nerve  taking  origin  from  three  cervical  segments.  The 
lesion  was  not  a  spinal  one,  i.  e.,  such  as  we  have  before  de- 
scribed, neither  was  it  one  involving  the  cells  of  origin  of 
this  nerve  in  the  spinal  cord.  The  awkward  position  of  the 
patients  and  their  naturally  great  strength  operated  to  in- 


K1G.  7.  Paralysis  of  right  serratus 
magnus.  Shows  outline  of  the 
vertebral  borders  of  the  scapulae 
when  arms  are  extended  forward. 


jure  them  in  much  the  same  way  as  the  various  nerve  holds 
practiced  by  the  jiu-jitsu  wrestler.  The  pressure  where  the 
nerve  crossed  the  ribs  became  too  great  and.,  hence,  caused 
a  severe  trauma  of  the  nerve. 

A  Unilateral   Cervical   Spinal   Lesion. — The   foregoing 
cases  present  the  classical  first  symptoms  of  a  severed  motor 


PRINCIPLES  OF  OSTEOPATHY  83 

nerve.  In  order  to  present  the  symptoms  accompanying  a 
cervical  lesion  of  the  spinal  lesion  type  we  will  describe  a 
case  which  has  been  under  observation  for  a  long  time.  A 
woman,  41  years  of  age,  has  been  under  my  professional 
care  for  three  years.  At  the  time  of  my  first  examination 


FIG.    8.     Shows    digitations    of    the       FIG.  9.     Paralysis  of  the  right  ser- 
serratus  rnagnus  and  normal  po-  ratus  magnus.    No  digitations  are 

sition  of  the  scapula.  apparent.     The   scapula  takes  an 

extreme   "wing"  position. 

she  appeared  to  be  constitutionally  ill,  but  careful  examina- 
tion failed  to  discover  any  organic  disease.  Functional 
rhythm  seemed  discordant  everywhere,  hence  our  first  ef- 
forts were  to  see  that  environment  was  fairly  normal.  Rest, 
nutritious  diet  and  an  optimistic  atmosphere  served  to  elim- 
inate many  of  the  irritating  symptoms. 


84  PRINCIPLES  OF  OSTEOPATHY 

The  first  examination  of  the  spinal  area  discovered  a 
lesion  between  the  sixth  and  seventh  cervical  vertebrae. 
There  was  muscular  ankylosis  controlling  this  articulation 
and  any  attempted  movement  of  the  whole  cervical  area, 
sufficient  to  make  demand  on  this  joint,  caused  pain  of  a 
sharp  neuralgic  character  to  radiate  into  the  left  shoulder 
and  arm.  This  pain  could  be  produced  most  easily  by  either 
voluntary  or  passive  rotation  of  the  head  to  the  left.  A  per- 
sistent effort  to  rotate  the  head  in  this  direction  caused  the 
hand  and  arm  to  become  numb.  The  hand  would  become 
bloodless,  cold  and  moist;  power  to  pick  up  a  book  or  cup 
was  greatly  lessened.  These  symptoms  would  wear  off  in 
twenty-four  to  thirty-six  hours,  but  the  pain  would  leave  her 
in  almost  a  state  of  collapse.  Massage  of  the  arm  and  hand 
would  bring  no  reaction ;  heat  also  failed  to  stimulate  cir- 
culation. 

These  attacks  had  been  brought  on  by  any  sort  of  house- 
work, at  first  only  sweeping  or  such  work  as  required  arm 
leverage.  Later  it  seemed  as  though  the  attacks  came  with- 
out any  mechanical  reason.  They  were  accompanied  by  se- 
vere headache,  tachycardia,  meteorism,  cold  extremities 
and  subnormal  temperature.  As  might  be  expected  in  such 
a  case  the  spinal  lesion  picture  was  a  mixed  one  and  it 
seemed,  in  view  of  so  many  symptoms  of  auto-intoxication, 
as  though  the  mid-dorsal  lesions  were  more  nearly  primary 
than  the  others.  The  sensitiveness  of  this  spinal  column 
was  so  great  and  so  many  compensations  were  in  evidence 
that  it  was  deemed  best  to  attempt  at  first  merely  to  simplify 
the  symptom  complex  as  much  as  possible  by  giving  the 
spinal  column  physiological  rest.  The  patient  was  kept  in 
bed,  thus  reducing  the  demand  on  the  weight  carrying  func- 
tion of  the  spine.  This,  and  the  psychological  influence  of 
trying  a  new  plan  under  optimistic  circumstances,  served  to 
reduce  the  number  and  complexity  of  symptoms,  but  in  no 
wise  changed  the  character,  or  viciousness,  of  the  reactions 
arising  from  any  disturbance  of  the  articulation  between  the 
sixth  and  seventh  cervical  vertebrae. 


PRINCIPLES  OF  OSTEOPATHY  85 

Treatment. — Direct  extension,  slow  and  gentle,  was  at- 
tempted with  marked  success.  Great  care  had  to  be  exer- 
cised when  releasing  the  extension,  else  the  closure  of  the 
cervical  articulations  acted  as  though  a  nerve  had  been 
caught  by  direct  pressure.  Gradually  the  muscular  tension 
around  this  joint  was  decreased  and  a  slight  degree  of  rota- 
tion toward  the  lesion,  i.  e.,  in  this  case  the  left  side,  could 
be  accomplished  without  arousing  severe  pain.  Digital  pres- 
sure made  against  the  left  side  of  the  sixth  cervical  spine 
would  always  cause  a  severe  reaction.  It  was  not  possible 
to  use  any  quick  leverage  or  thrusting  movements  in  this 
case  for  correction  of  the  lesion  until  about  eighteen  months 
after  we  gave  our  initial  treatment.  A  fairly  wide  range  of 
movement  is  now  possible.  The  patient  can  voluntarily 
rotate  the  head  to  the  left,  but  the  sensitiveness  on  the  left 
side  of  the  cervical  spine  has  never  entirely  disappeared. 
She  lives  a  normal  existence  as  a  busy  housewife.  She  has 
gained  thirty  pounds  in  weight. 

In  this  case  the  lesion  is  nearer  center,  i.  e.,  closer  to 
the  spinal  cord.  The  symptoms  it  presents'  are  nearer  in 
character  to  those  of  true  central  origin,  except  that  they 
are  unilateral.  The  local  symptoms,  pain,  muscular  tension, 
anaesthesia  and  vaso-constriction,  are  manifested  in  the  area 
of  distribution  of  the  brachial  plexus.  Although  the  spinal 
muscles,  whose  tension  constituted  an  ankylosis  of  the  artic- 
ulation between  the  sixth  and  seventh  cervical  vertebrae,  are 
innervated  by  branches  of  the  posterior  division  of  the  lower 
cervical  nerves,  the  reflexes,  through  the  cells  of  origin  of 
the  lower  cervical  nerve  trunks  in  the  spinal  cord,  were 
manifested  in  all  divisions  of  the  brachial  plexus,  not  only  in 
the  plexus  but  overflowed  into  the  sympathetics,  as  shown 
by  the  vaso-motor  disturbance  and  rapid  heart  action. 

There  is  a  history  of  accident  in  this  case  which  classes 
this  lesion  as  traumatic.  We  have  its  effects  shown  in  the 
reaction  of  the  cerebro-spinal  and  sympathetic  systems.  In 
other  words,  the  somatic  and  splanchnic  structures,  inner- 
vated by  nerves  from  the  lower  cervical  group,  act  and  react 


86  PRINCIPLES  OF  OSTEOPATHY 

upon  each  other  in  an  effort  to  adapt  themselves  to  this 
lesion.  As  time  went  on  the  whole  body  was  engaged  in  a 
losing  effort  at  adaptation,  simpHr  because  the  lesion  area 
was  never  given  physiological  rest,  i.  c.,  eliminating  all  de- 
mand on  the  weight  carrying  and  balancing  functions  of  the 
joint.  The  manipulation  of  this  spinal  joint  was  also  in  the 
nature  of  physiological  rest  because  it  reduced  the  hyper- 
tension and  gradually  reestablished  normal  functional  move- 
ments. 


FIG.  10.  Paralysis  of  the  trapozius 
and  clavicular  division  of  the 
sterno-cleido-mastoid  due  to  death 
of  some  of  tiie  central  cells  of 
the  spinal  accessory  nerve. 


Involvment  of  the  Central  Nerve  Cells. — The  next  step 
in  severity  in  lesions  is  the  involvment  of  the  contents  of  the 
spinal  canal,  either  through  direct  invasion  of  the  tissues  of 
the  cord,  or  by  pressure  due  to  destruction  of  sections  of  the 
spinal  column.  The  point  we  wish  to  illustrate  is  that  the 
diagnostician  must,  in  order  to  do  scientific  work,  make  a 
diagnosis  based  on  the  facts  of  anatomy  as  interpreted  by 
embryology.  If  symptoms  were  noted  and  interpreted  with 
the  same  precision  with  which  the  trouble  man  on  a  tele- 
phone system  works  out  his  problems  we  would  not  find  so 


PRINCIPLES  OF  OSTEOPATHY 


87 


many  fantastic  medical  theories.  It  is,  in  large  measure,  the 
failure  to  teach  the  fundamentals  of  anatomy,  physiology 
and  pathology  in  a  thorough  manner  that  is  responsible  for 
the  vagaries  in  medical  practice.  We  are  not  forgetting  the 


FIG.    11.     Atrophy  of  right  trapezius. 

fact  that  the  public  is  not  educated  to  this  view  and,  there- 
fore, the  one  who  attempts  to  act  irrespective  of  the  public's 
state  of  education  has  a  hard  row  to  hoe. 

Cervical  Muscles. — In  the  first  case  described,  wherein 
the  Serratus  Magnus  was  paralyzed,  we  noted  that  it  re- 
ceives its  innervation  from  the  cervical  region.  This  makes 
it  a  cervical  muscle.  In  this  same  sense  the  trapezius  and 
latissimus  dorsi  are  cervical  muscles  and  will  necessarily 
enter  into  any  reactions  involving  the  segments  of  the  spinal 
cord  which  give  origin  to  their  nerves.  In  order  to  bring 
to  your  attention  some  of  these  peculiar  changes  which  have 


88 


PRINCIPLES  OF  OSTEOPATHY 


taken  place  in  the  development  of  the  body,  we  will  review 
a  few  of  the  most  notable  which  will  aid  us  in  the  interpre- 
tation of  the  effects  of  lesions. 

Embryology.  —  Embryology   is    the   "histology   of   very 
young  beings."     \Ye  may  question  here  what  contribution 


FIG.     12.     Shows    atrophy    of    right 
trapezius. 

the  study  of  embryology  has  made  which  has  practical  sig- 
nificance in  the  diagnostic  and  therapeutic  work  of  our  prac- 
titioners. Since  we  have  a  "division  of  labor,"  as  evidenced 
by  a  variety  of  tissues  having  special  functions,  and  since 
self-preservation  for  purposes  of  perpetuating  organisms  of 
a  similar  character  is  a  prime  requisite  of  life,  groups  of  tis- 
sues are  associated  into  mechanisms.  Comparative  embry- 
ology has  helped  us  to  recognize,  in  part,  these  mechanisms. 
The  recognition  of  the  segmental  arrangement  of  the  body 
is  one  of  the  great  contributions  of  embryologists. 


PRINCIPLES  OF  OSTEOPATHY 


89 


Segmentation. — Early  in  the  development  of  the  em- 
bryo the  mesodermic  cells  on  either  side  of  the  longitudinal 
groove  show  transverse  divisions  which  form  a  series  of  seg- 
ments called  protovertebrae  or  mesodermic  somites.  With- 


FIG.  13.     Paralysis  of  right  trapezius  and  portion  of  the  sterno- 
cleido-mastoid. 

out  our  going  into  a  lengthy  description  of  the  arrangement 
of  the  mesodermic  cells  to  form  the  spinal  column  and  its 
muscles,  we  want  this  early  series  of  divisions  kept  in  mind. 
"The  appearance  of  the  mesodermic  somites  is  an  im- 
portant phenomenon  in  the  development  of  the  embryo, 
since  it  influences  fundamentally  the  future  structure  of  the 
organism.  If  each  pair  of  mesodermic  somites  be  regarded 
as  an  element  and  termed  a  metamere  or  segment,  then  it 
may  be  said  that  the  body  is  composed  of  a  series  of  meta- 
meres,  each  more  or  less  resembling  its  fellows,  and  succeed- 
ing one  another  at  regular  intervals.  Each  somite  differen- 
tiates, as  has  been  stated,  into  a  scleratome  and  a  myotome, 
and,  accordingly,  there  will  primarily  be  as  many  ver- 
tebrae and  muscle  segments  as  there  are  mesodermic 


90  PRINCIPLES  OF  OSTEOPATHY 

somites,  or,  in  other  words,  the  axial  skeleton  and  the 
voluntary  muscles  of  the  trunk  are  primarily  metameric. 
Nor  is  this  all.  Since  each  metamere  is  a  distinct  unit,  it 
must  possess  its  own  supply  of  nutrition,  and  hence  the  pri- 
mary arrangement  of  the  blood-vessels  is  also  metameric,  a 
branch  passing  off  on  either  side  from  the  main  longitudinal 
arteries  and  veins  to  each  metamere.  And,  further,  each  pair 
of  muscle  segments  receives  its  own  nerves,  so  that  the  ar- 
rangement of  the  nerves,  again,  is  distinctly  metameric. 

"This  metamerism  is  most  distinct  in  the  neck  and  trunk 
regions,  and  at  first  only  in  the  dorsal  portions  of  these  re- 
gions, the  ventral  portions  showing  metamerism  only  after 
the  extension  into  them  of  the  myotomes.  But  there  is  clear 
evidence  that  the  arrangement  extends  also  into  the  head 
and  that  this,  like  the  rest  of  the  body,  is  to  be  regarded  as 
composed  of  metameres.  There  is  reason,  therefore,  for  be- 
lieving that  the  fundamental  arrangement  of  all  parts  of  the 
body  is  metameric,  but  though  this  arrangement  is  clearly 
defined  in  early  embryos,  it  loses  distinctness  in  latter 
periods  of  development.  But  even  in  the  adult  the  primary 
metamerism  is  clearly  indicated  in  the  arrangement  of  the 
nerves  and  of  parts  of  the  axial  skeleton,  and  careful  study 
frequently  reveals  indications  of  it  in  highly  modified  mus- 
cles and  blood-vessels 

"Although  the  dermal  mesenchyme  is  unsegmental  in 
character,  yet  the  nerves  which  send  branches  to  it  are  seg- 
mental,  and  it  might  be  expected  that  indications  of  this  con- 
dition would  be  retained  by  the  cutaneous  nerves,  even  in 
the  adult.  A  study  of  the  cutaneous  nerve-supply  in  the 
adult  realizes  to  a  very  considerable  extent  this  expectation, 
the  areas  supplied  by  the  various  nerves  forming  more  or 
less  distinct  zones  and  being,  therefore,  segmental.  But  a 
considerable  commingling  of  adjacent  areas  has  also  oc- 
curred. Thus,  while  the  distribution  of  the  cutaneous 
branches  of  the  fourth  thoracic  nerve,  as  determined  experi- 
mentally in  the  monkey  (Macacus),  is  distinctly  zonal  or 
segmental,  the  nipple  lying  practically  in  the  middle  line  of 


PRINCIPLES  OF  OSTEOPATHY 


91 


the  zone ;  the  upper  half  of  its  area  is  also  supplied  or  over- 
lapped by  fibers  of  the  third  nerve  and  the  lower  half  by 
fibers  of  the  fifth,  Fig.  14,  so  that  any  area  of  skin  in  the 
zone  is  innervated  by  fibers  coming  from  at  least  two  seg- 


in  Dorsol 


Y  Dorsal 


>:  *•'••:  x  ^SXsSSSXSSSiSSN 


IT  Dorsol 


FIG.    14.     Showing   overlapping   of   segmental   sensory   nerves     Drawn   by 
John  Comstock   (after  Sherrington). 

mental  nerves  (Sherrington).  And  furthermore,  the  dis- 
tribution of  each  nerve  crosses  the  mid-ventral  line  of  the 
body,  forming  a  more  or  less  extensive  crossed  overlap. 

"And  not  only  is  there  a  confusion  of  adjacent  areas, 
but  an  area  may  shift  its  position  relatively  to  the  deeper 
structures  supplied  by  the  same  nerve,  so  that  the  skin  over 
a  certain  muscle  is  not  necessarily  supplied  by  fibers  from 
the  nerve  which  supplies  the  muscle.  Thus,  in  the  lower 
half  of  the  abdomen,  the  skin  at  any  point  will  be  supplied 
by  fibers  from  higher  nerves  than  those  supplying  the  un- 
derlying muscles  (Sherrington),  and  the  skin  of  the  limbs 
may  receive  twigs  from  nerves  which  are  not  represented  at 
(all  in  the  muscle-supply  (second  and  third  thoracic  and  third 
sacral)." 

Widespread  Influence  of  a  Spinal  Lesion. — No  skin 
area  (or  individual  muscle)  is  supplied  wholly  by  fibers  from 
one  segment  of  the  spinal  cord,  but,  in  fact,  is  innervated  by 
a  nerve  made  up  of  fibers  from  two  or  more  segments.  A 


92  PRINCIPLES  OF  OSTEOPATHY 

spinal  lesion  of  traumatic  origin,  granting  that  only  one  ar- 
ticulation is  involved,  will  influence,  in  some  cases,  widely 
separated  structures.  For  example :  A  lesion  between  the 
fourth  and  fifth  cervical  vertebrae  might  influence  the  dia- 
phragm, latissimus  dorsi  and  trapezius,  and  through  the 
spinal  accessory  the  muscles  of  the  larynx.  Such  apparent- 
ly widely  separated  structures  must  be  kept  in  mind  when 
considering  a  lesion  at  the  location  under  discussion.  Nor 
is  this  enough,  because  skin  areas  must  be  reckoned  with. 

To  learn  these  tissue  associations,  through  the  study 
of  anatomy,  is  quite  possible,  but  embryology  furnishes  an 
interpretation  which  tends  to  keep  them  in  one's  mind. 
When  we  know  that  the  diaphragm,  trapezius  and  latissimus 
dorsi  are  essentially  cervical  muscles  which  have  migrated 
but  remain  under  the  control  of  cervical  nerves,  we  cease  to 
think  of  one  as  the  dividing  wall  between  thorax  and  abdo- 
men, a  great  muscle  of  respiration ;  the  others  as  constitut- 
ing the  first  layer  of  dorsal  muscles. 

Association  of  Muscles  Innervated  by  the  Same  Seg- 
ment.— Such  structures,  as  we  have  just  mentioned,  have 
migrated  far  from  their  original  segments  and  have  taken 
on  functions  and  are  concerned  in  reactions  which  are  no 
longer  segmental  but  have  for  their  aim  the  preservation  of 
the  whole  body,  hence  any  injury  to  one,  or  all,  of  them 
would  tend  to  produce  a  reflex  localized  in  the  segment  from 
which  they  received  their  innervation.  Compare  with  these 
migrated  structures  a  segmental  muscle  of  primitive  charac- 
ter like  the  intertransversalis  or  interspinalis.  The  influence 
of  these  primitive  muscles  is  wholly  on  the  one  articulation, 
but  they  are  part  of  the  mechanism  supplied  from  the  same 
segment  as  the  migrated  muscles.  These  small  muscles, 
which  are  the  intrinsic  muscles  of  the  spinal  arthrodial 
joints,  are  important  prime  movers  in  the  effort  to  maintain 
the  erect  position,  i.  e.,  they  enter  into  the  weight  carrying 
and  balancing  functions  of  the  spinal  column.  In  case  of 
their  injury,  a  spinal  lesion,  the  lost  motion  in  the  joint 
causes  widespread  influences,  as  heretofore  mentioned.  The 


PRINCIPLES  OF  OSTEOPATHY  93 

fifth  layer  of  dorsal  muscles,  according  to  Gray,  consists  of 
a  network  of  small  muscles,  the  deepest  of  which  extend 
between  portions  of  two  adjoining  vertebrae;  more  super- 
ficially placed  layers  extend  greater  distances  so  as  to  influ- 
ence the  movements  between  more  than  two  vertebrae.  The 
next  layer  of  muscles,  consisting  of  the  erector  spinae  and  its 
continuations,  influence  a  greater  number  of  vertebrae  and 
bring  rib  positions  under  the  influence  of  cervical  nerves. 
The  splenius  capitis  et  colli,  of  the  third  layer,  and  the  rhom- 
boids, of  the  second  layer,  are  likewise  supplied  by  cervical 
nerves.  Thus  we  find  the  nerve  which  takes  its  exit  between 
the  fifth  and  sixth  cervical  vertebrae  supplies  a  series  of  over- 
lapping muscles,  the  first  one  supplied,  intertransversalis, 
being  wholly  intrinsic  to  the  spine  and  the  one  on  the  sur- 
face of  the  body,  the  latissimus  dorsi,  having  a  very  wide- 
spread influence. 

Effect  of  Sectioning  Single  Spinal  Nerve. — To  cut  the 
fifth  cervical  nerve  at  its  exit  from  the  intervertebral  fora- 
men would  not  paralyze  any  but  the  intrinsic  spinal  muscles 
between  the  fifth  and  sixth  cervical  vertebrae.  All  muscles 
beyond  that  point  would  be  weakened  in  proportion  to  the 
number  of  fibers  their  governing  nerves  received  from  that 
cut  trunk.  In  other  words,  it  appears  probable  that  the  sev- 
ering of  the  pair  of  nerves,  the  fifth  cervical,  could  weaken 
the  gross  movements  made  by  muscles  innervated  by  them, 
but  since  only  the  intrinsic  spinal  muscles  of  one  interverte- 
bral articulation  are  wholly  supplied  by  them  there  would 
be  no  complete  muscular  paralysis  apparent.  The  sixth  cer- 
vical nerves  innervate  about  twenty-eight  pairs  of  muscles 
in  the  neck,  chest,  shoulders  and  upper  extremities  and  back, 
and  the  diaphragm. 

Developmental  Changes  in  Muscles. — This  gives  us 
some  idea  of  the  great  changes  that  have  been  consummated 
in  the  development  of  the  body.  The  many  changes  in  posi- 
tion and  direction  of  fibers  are  recognized  through  the  fact 
that  they  remain  under  the  nerve  control  of  the  one  seg- 
ment. The  various  changes  in  the  development  of  muscles 


94  PRINCIPLES  OF  OSTEOPATHY 

are  thus  described  by  McMurrich :  "It  may  be  seen  that  the 
changes  which  occur  in  the  myotomes  may  be  referred  to 
one  or  more  of  the  following  processes : 

"1.  A  longitudinal  splitting  into  two  or  more  portions, 
a  process  well  illustrated  by  the  trapezius  and  sternomas- 
toid,  which  have  differentiated  by  the  longitudinal  splitting 
of  a  single  sheet  and  contain,  therefore,  portions  of  the  same 
myotomes.  The  sterno-hyoid  has  also  differentiated  by  the 
same  process,  and  indeed,  it  is  of  frequent  occurrence. 

"2.  A  tangential  splitting  into  two  or  more  layers. 
Examples  of  this  are  also  abundant  and  are  afforded  by  the 
muscles  of  the  fourth,  fifth  and  sixth  layers  of  the  back,  as 
recognized  in  English  textbooks  of  anatomy,  by  the  two 
oblique  and  transverse  layers  of  the  abdominal  walls,  and 
by  the  intercostal  muscles  and  the  transversus  of  the  thorax. 

"3.  A  fusion  of  portions  of  successive  myotomes  to 
form  a  single  muscle,  again  a  process  of  frequent  occur- 
rence, and  well  illustrated  by  the  rectus  abdominis  (which 
is  formed  by  the  fusion  of  the  ventral  portions  of  the  last  six 
or  seven  thoracic  myotomes)  and  by  the  superficial  portions 
of  the  erector  spinae. 

"4.  A  migration  of  parts  of  one  or  more  myotomes  over 
others.  An  example  of  this  process  is  to  be  found  in  the 
latissimis  dorsi  whose  history  has  already  been  referred  to, 
and  it  is  also  beautifully  shown  by  the  serratus  anterior  and 
the  trapezius,  both  of  which  have  extended  far  beyond  the 
limits  of  the  segments  from  which  they  are  derived. 

"5.  A  degeneration  of  portions  or  the  whole  of  a  myo- 
tome.  This  process  has  played  a  very  considerable  part  in 
the  evolution  of  the  muscular  system  in  the  vertebrates. 
When  a  muscle  normally  degenerates,  it  becomes  converted 
into  connective  tissue,  and  many  of  the  strong  aponeurotic 
sheets  which  occur  in  the  body  owe  their  origin  to  this  pro- 
cess. Thus,  for  example,  the  aponeurosis,  connecting  the 
occipital  and  frontal  portions  of  the  occipito-frontalis  is  due 
to  this  process  and  is  muscular  in  such  forms  as  the  lower 
monkeys,  and  a  good  example  is  also  to  be  found  in  the  apo- 


PRINCIPLES  OF  OSTEPOATHY  95 

neurosis  which  occupies  the  interval  between  the  superior 
and  inferior  serrati  postici,  these  two  muscles  being  contin- 
uous in  lower  forms.  The  strong  lumbar  aponeurosis  of  the 
oblique  and  transverse  muscles  of  the  abdomen  are  also  good 
examples. 

"Indeed,  in  comparing  one  of  the  mammals  with  a  mem- 
ber of  one  of  the  lower  classes  of  vertebrates,  the  greater 
amount  of  connective  tissue  compared  with  the  amount  of 
muscular  tissue  in  the  former  is  very  striking,  the  inference 
being  that  these  connective-tissue  structures  (fasciae,  apo- 
neurosis, ligaments)  represent  portions  of  the  muscular  tis- 
sue of  the  lower  form  (Bardeleben).  Many  of  the  accessory 
ligaments  occurring  in  connection  with  diarthrodial  joints, 
apparently  owe  their  origin  to  a  degeneration  of  muscle  tis- 
sue, the  fibular  lateral  ligament  of  the  knee  joint,  for  in- 
stance, being  probably  a  degenerated  portion  of  the  per- 
oneous  longus,  while  the  sacro-tuburous  ligament  appears 
to  stand  in  a  similar  relation  to  the  long  head  of  the  biceps 
femoris  (Sutton). 

"Finally,  there  may  be  associated  with  any  of  the  first 
four  processes  a  change  in  the  direction  of  the  muscle-fibers. 
The  original  antero-posterior  direction  of  the  fibers  is  re- 
tained in  comparatively  few  of  the  adult  muscles  and  excel- 
lent examples  of  the  process  here  referred  to  are  to  be  found 
in  the  intercostal  muscles,  and  the  muscles  of  the  abdominal 
walls.  In  the  musculature  associated  with  the  branchial 
arches  the  alteration  in  the  direction  of  the  fibers  occurs 
even  in  the  fishes,  in  which  the  original  direction  of  the 
muscle-fibers  is  very  perfectly  retained  in  other  myotomes, 
the  branchial  .muscles,  however,  being  arranged  parallel 
with  the  branchial  cartilages  or  even  passing  dorso-ven- 
trally  between  the  upper  and  lower  portions  of  an  arch,  and 
so  forming  what  may  be  regarded  as  a  constrictor  of  the 
arch.  This  alteration  of  direction  dates  back  so  far  that 
the  constrictor  arrangement  may  well  be  taken  as  the  pri- 
mary conditions  in  studying  the  changes  which  the  branchial 
musculature  has  undergone  in  the  mammalia." 


96  PRINCIPLES  OF  OSTEOPATHY 

Please  note  that,  "since  the  relation  between  a  nerve 
and  the  myotome  belonging  to  the  same  is  established  at  a 
very  early  period  of  development  and  persists  throughout 
life,  no  matter  what  changes  of  fusion,  splitting  or  migra- 
tion the  myotome  may  undergo,  it  is  possible  to  trace  out 
more  or  less  completely  the  history  of  the  various  myotomes 
by  determining  their  segmental  innervation."  In  view  of  this 
the  clinician  ought  to  be  well  versed  in  the  knowledge  of  an- 
atomy, i.  e.,  the  gross  structures  innervated  from  the  same 
segment  of  the  cord.  Much  of  the  physical  diagnostic  work 
of  the  osteopath  is  based  on  the  fundamental  facts  of  em- 
bryology and  anatomy,  i.  e.,  metamerism. 


PRINCIPLES  OF  OSTEOPATHY  97 


CHAPTER  VI. 

THE  NERVOUS  SYSTEM. 

The  Medium  of  Communication. — A  masterful  knowl- 
edge of  nerve  tissue  and  its  arrangement  in  the  body  to  form 
the  nervous  system  is  an  absolute  prerequisite  for  success 
in  osteopathic  practice.  Every  vital  phenomenon  calls  for 
interpretation  by  the  skillful  physician.  Interpretation  can- 
not be  attempted  without  a  definite  knowledge  of  structure 
and  function  of  that  tissue  which  acts  as  a  medium  of  com- 
munication between  all  other  elements  of  the  body. 

The  name  of  our  system,  Osteopathy,  calls  attention 
primarily  to  osseous  structure,  but  it  is  only  in  connection 
with  its  effects  on  the  tissues  of  communication  and  ex- 
change, vital  phenomena,  we  are  actually  interested. 

The  Attributes  of  Nerve  Tissue. — All  physiological 
phenomena  are  characterized  by  the  manifestation  of  at- 
tributes of  nerve  tissue,  irritability,  conductivity  and  tro- 
phicity.  Motion,  sensation  and  nutrition  are  the  vital  phe- 
nomena whose  perversion  constitutes  disease.  Therefore, 
whatever  the  pathological  condition  may  be,  we  are  called 
upon  to  note  a  change  in  some  one  or  all  of  these  attributes 
of  nerve  tissue. 

Nerve  and  Muscle  Irritability. — Scarcely  any  thought 
of  muscle  is  ever  complete  without  the  nerve  impulse  which 
controls  the  muscle  is  also  considered.  For  convenience  sake 
we  may  separate  nerve  and  muscle  when  teaching  their  spe- 
cial attributes,  but  for  all  practical  purposes  they  are  never 
separated.  Muscle  and  nerve  are  both  irritable,  but  we  pay 
no  attention  to  the  irritability  of  muscle  because  under  nor- 
mal conditions  we  do  not  see  any  evidences  of  specific  mus- 


98  PRINCIPLES  OF  OSTEOPATHY 

cular  irritability.  We  view  muscular  irritability  as  the  re- 
sult of  nerve  irritability.  Therefore  nerve  tissue  is  the  chief 
irritable  tissue.  Irritability  is  an  attribute  of  cell  proto- 
plasm whereby  chemical  and  physical  phenomena  are  en- 
acted in  response  to  irritants.  Irritants  may  be  mechanical, 
chemical,  thermal  and  electrical.  Practically  all  that  physi- 
ologists know  of  the  reactions  of  nerve  tissue  to  irritants  has 
been  derived  through  experimentation  by  means  of  the  elec- 
trical current.  Osteopathists  are  bringing  to  light  many 
facts  concerning  mechanical  stimulation.  Hydrotherapists 
have  demonstrated  the  utility  of  thermal  stimuli.  Drug 
therapy  makes  use  of  the  chemical  form  of  stimulation. 

Conductivity. — Nerve  tissue  is  not  only  irritable  but 
possesses  the  ability  to  transmit  its  irritability  to  other  tis- 
sues and  cause  certain  activities  to  be  initiated  there.  Con- 
ductivity, the  second  vital  attribute  of  nerve  tissue,  is  the 
power  to  carry  impulses  from  the  point  of  irritation  to  other 
points  in  the  nervous  system.  Irritability  would  be  of  small 
moment  if  conductivity  were  not  present  to  transmit  the 
message  to  the  center  and  arouse  response.  The  nerve  cell 
and  its  axis-cylinder  are  a  continuous  mass  of  protoplasm 
and  as  long  as  the  continuity  is  maintained  conductivity  will 
be  maintained. 

Trophicity. — The  third  attribute  of  nerve  tissue,  tro- 
phicity,  is  very  imperfectly  understood.  We  do  not  use  this 
term  here  to  represent  so  much  the  nutritional  influences  of 
the  cell-body  over  its  axis-cylinder  as  the  influence  exerted 
by  nerve  tissue  over  other  body  tissues,  causing  them  to 
grow  and  prosper.  This  nutritional  influence  over  other 
tissues  is  an  attribute  which  we  are  compelled  to  note  quite 
frequently  in  practice.  There  are  individuals  in  whom  motion 
and  sensation  are  normal  but  nutrition  fails,  hence  we  note 
that  in  some  cases  mechanical  lesions  may  cause  only  a 
slight  change  in  the  nerve  tissue  upon  which  they  impinge, 
and  this  change  is  manifested  by  variation  in  nutrition  of 
the  part  controlled  by  the  irritated  nerve.  It  is  probably 
this  attribute  of  nerve  tissue  which  is  perverted  or  lost  when 


PRINCIPLES  OF  OSTEOPATHY  99 

the  tissues  refuse  to  take  up  certain  chemical  elements  which 
are  ordinarily  normal  to  them ;  for  example,  iron.  In  osteo- 
pathic  practice  we  consider  nutritional  disorders  as  being 
the  result  of  perverted  trophic  influence  of  nerves.  Of  course 
in  cases  where  it  is  known  that  the  ingested  food  does  not 
contain  the  required  element  or  elements  we  must  regulate 
the  diet.  But  there  are  many  cases  where  all  conditions  ap- 
pear normal,  except  that  the  tissues  do  not  take  up  nourish- 
ment as  they  should.  In  these  cases  we  search  for  lesions 
in  the  same  way  we  would  if  motion  or  sensation  showed 
perversion  or  loss.  This  phase  of  our  subject  can  best  be 
considered  at  another  time. 

Unity  of  the  Nervous  System. — The  unity  of  the  nervous 
system  is  a  physiological  fact,  and  this  brings  deep  and 
superficial  areas  in  close  relation.  Every  portion  of  the  body 
is  able  through  the  medium  of  the  nervous  system  to  work 
in  harmony  with  every  other  part.  Physiologists  divide  the 
nervous  system  into  central  and  peripheral  portions,  but 
for  practical  purposes  this  division  is  of  little  use  to  us  when 
attempting  to  make  use  of  the  irritability  and  conductivity 
of  the  nervous  system  for  therapeutic  purposes.  Since  all 
portions  of  the  nervous  system  are  connected  there  must  be 
some  place  where  impressions  made  upon  terminal  nerve 
filaments  may  be  assembled,  co-ordinated  and  responded  to 
harmoniously.  Wherever  large  numbers  of  nerve  cells  are 
assembled  we  expect  to  find  such  duties  performed. 

Other  Systems  of  Integration. — Any  influence  which  we 
have  upon  the  body  through  therapeutic  methods  must  be 
based  on  the  unity  of  the  body.  That  the  body  is  a  unit 
must  be  constantly  borne  in  mind,  not  only  a  unit  because 
of  the  nervous  system  but  also  a  mechanical  unit,  formed  by 
its  fibrous  tissues  and  a  chemical  unit  through  its  circulating 
.media.  The  nervous  system  is  so  preeminently  the  master 
tissue  that,  when  we  think  of  any  integrative  reaction,  we 
attribute  it  to  this  tissue,  which  not  only  takes  note  of  im- 
pressions secured  by  contact  but  reaches  out  into  surround- 
ing space  and  causes  the  body  to  react  to  things  at  a  distance. 


100  PRINCIPLES  OF  OSTEOPATHY 

Mechanical  Irritation. — The  particular  therapeutic  pro- 
cedures with  which  we  are  here  dealing  are  aimed  to  affect 
by  contact  and  hence  we  are  most  interested  in  those  re- 
flexes originating  through  stimuli  applied  to  skin,  visceral 
and  somatic  tissues.  Structural  displacements  in  the  human 
body  act  as  mechanical  irritants  to  nerve  tissue,  changing 
the  chemical  and  physical  condition  of  the  protoplasm  and 
thus  altering  its  irritability,  either  plus  or  minus  according 
to  the  intensity  of  the  stimulation.  The  displaced  structures 
may  have  other  detrimental  influences  on  nerve  tissue,  for 
instance  the  pressure  brought  to  bear  on  the  nourishing 
liquids  surrounding  the  nerve,  i.  e.,  the  blood  and  lymph, 
may  cause  sufficient  chemical  change  in  these  liquids  to 
materially  affect  irritability  of  the  protoplasm  of  the  nerves 
which  they  are  expected  to  nourish. 

Effect  on  Conductivity. — Conductivity  is  not  destroyed 
by  these  slight  mechanical  pressures.  If  the  protoplasm  of 
the  cell  and  axis-cylinder  were  unable  to  conduct  impulses 
and  project  them  in  such  manner  as  to  reach  other  cell 
bodies  of  the  nervous  system  our  work  would  be  very  lim- 
ited. Conductivity  depends  on  the  continuity  of  protoplasm. 
The  mechanical  irritations  we  deal  with  in  osteopathic  prac- 
tice seldom  destroy  conductivity.  If  they  did  so  they  would 
cease  to  become  irritants  the  moment  conductivity  was  lost. 
Other  irritants  may  act  for  a  time  on  the  severed  portions  of 
protoplasm,  but  the  original  lesion  would  have  destroyed 
the  continuity  of  the  protoplasm. 

Afferent  and  Efferent  Fibers. — The  fibers  composing  a 
nerve  bundle  may  be  efferent  or  afferent  so  far  as  direction, 
of  impulse  is  concerned.  Efferent  fibers  may  be  further  dif- 
ferentiated by  the  names,  motor,  vaso-motor,  secretory,  ac- 
cording to  the  structures  in  which  they  end.  Afferent  fibers 
are  usually  termed  sensory  to  denote  their  function  of  carry- 
ing impulses  to  the  central  nervous  system.  Nerve  trunks 
contain  all  of  these  various  fibers,  therefore,  pressure  will 
irritate  all  of  the  fibers  and  conductivity  of  individual  fibers 
will  transmit  the  impulses  in  the  direction  of  the  normal 


PRINCIPLES  OF  OSTEOPATHY  101 

nerve  impulse,  thus  causing  contraction  in  the  voluntary  or 
involuntary  muscles  or  activity  of  secretory  tissues;  sensory 
impulses  will  be  transmitted  to  the  central  nervous  system 
and  will  purport  to  come  from  the  terminal  distribution  of 
the  sensory  nerve.  If  the  afferent  impulse  is  such  a  one  as 
will  reach  the  patient's  consciousness,  we  find  that  the  cen- 
tral cells  are  misled  as  to  the  location  of  the  stimulus  and 
hence  manifest  a  response  in  the  supposed  area.  It  is  not 
necessary  for  the  patient  to  be  conscious  of  any  irritation  in 
order  to  bring  about  this  result. 

Organization  of  the  Nerve  Bundle. — The  organization 
of  the  nerve  bundle  complicates  our  ideas  of  irritability  and 
conductivity  in  the  protoplasm  of  the  cell  and  axis-cylinder 
of  a  nervous  unit.  Complexity  of  action  and  reaction  in- 
creases as  we  near  the  central  nervous  system.  We  have 
considered  that  all  impulses  generated  in  the  protoplasm  of 
a  nerve  cell  and  axis-cylinder  have  been  transmitted<  to  all 
parts  of  that  unit  of  nerve  tissue,  but  have  not  in  any  way 
influenced  any  other  unit.  We  have  not  considered  the  rela- 
tions of  cell  bodies  in  the  central  system.  It  is  sufficient  for 
our  present  purpose  to  note  that  the  afferent  fibers  enter  the 
spinal  cord  as  the  posterior  roots  and  that  their  cells  are  in 
the  ganglia  of  these  posterior  roots. 

Intraspinal  Fibers. — The  efferent  fibers  leave  the  cord 
as  its  anterior  roots  and  their  bodies  are  located  in  the  an- 
terior cornua  of  the  gray  matter  of  the  cord.  Upon  careful 
study  of  the  spinal  cord  there  are  found  other  cells  and  axis- 
cylinders  which  do  not  leave  the  cord  but  serve  to  connect 
the  afferent  and  efferent  elements  and  distribute  impulses 
within  the  cord.  These  latter  are  found  in  enormous  num- 
bers in  all  portions  of  the  central  nervous  system. 

Segmentation  of  the  Spinal  Cord. — The  first  fact  of 
great  interest  to  us,  osteopathically,  is  the  segmentation  of 
the  spinal  cord.  This  is  only  relative  in  character,  but  yet 
is  apparent,  not  only  histologically  but  pathologically.  We 
note  that  according  to  distribution  of  afferent  fibers  in  the 


102 


PRINCIPLES  OF  OSTEOPATHY 


N.  to  rectus  loterolu 
i  antic.  minor. 
untn  typoglossal 

with  pneumogastnc. 
to  rectus  antic,  major. 
S.  to  masloid   region 
<ireat  auricular  N. 

Tranwene  cervical  N. 
peziui,  Ang  scop  and 
uhomboidr 

Supra  clavicular  N. 
.....  --Supra  acrpmial  N. 
•Phreni 
" 


. 

N  to  pectoralii  major. 

-Circutnfle*  N. 

Muscuio  cutarvN. 
•Median-  N. 
•Radial  N. 

..............  —  UlnorN. 

Internal  cutaneous  N. 
LLe»er  internal  cutaneous  N. 


N. 
— llvo-inguinal  N. 

Ext. cutaneous  N. 
-•Genito- crural  N. 


Anterior  crural  (CemoratyN. 
Obturator  N. 


-Superior  gluteal  N. 

N.to  pyriforrrus . 

N  to  gemellui  superior 

N  to  gerneilui  inferior. 

N  to  ouadratus. 

— Small  sciatic  N 
•5aatic.N 

FIG.  15.  Diagram  of  spinal  segmentation,  showing  relation  between  the 
points  of  origin  of  the  spinal  nerves  and  their  points  of  emergence 
from  the  spinal  column;  also  their  distribution  to  the  muscles. 
Drawn  by  John  Comstock  (after  Dejerine  et  Thomas,  modified  by 
Starr). 


N.  10  Icvotor  oni 
N. ..  Obturator  int- 
N.  ••  Sphincter  ant 
Cocc^geal    N- 


PRINCIPLES  OF  OSTEOPATHY 


103 


spinal  cord  impulses  are  diffused  both  above  and  below  the 
point  of  entrance.  The  cell  bodies  of  the  anterior  roots  are 
also  somewhat  diffused,  but  in  practice  we  note  that  afferent 
and  efferent  impulses  seem  to  be  correlated  within  compara- 
tively narrow  limits  in  the  spirial  cord.  How  the  impulses 
set  up  in  the  protoplasm  of  an  afferent  fiber  are  transmitted 
from  it  to  the  protoplasm  of  other  cells  located  in  the  spinal 
cord  and  thence  transmitted  to  the  protoplasm  of  efferent 
cells  is  not  known,  nor  is  it  necessary  for  us  to  thoroughly 
understand  the  method  in  this  instance  so  long-  as  we  recog- 


Pdsterior 
root 


FIG.  16.     Diagram  showing  two  segments  of  the  spinal  cord. 

nize  the  results.  Our  specific  knowledge  must  comprehend 
the  exact  point  of  entrance  to  and  exit  from  the  spinal  cord 
of  each  nerve  bundle  and  the  peripheral  distribution  of  the 
same.  Having  a  knowledge  of  the  structure,  the  function 
comes  naturally  as  a  result. 

Segmental  Integration. — A  segment  of  the  spinal  cord, 
i.  e.,  that  portion  giving  rise  to  a  pair  of  spinal  nerves  may 
be  conceived  to  act  independently  of  other  segments.  Of 
course  it  would  be  difficult  to  demonstrate  this,  but  for  pur- 
poses of  analysis  we  may  be  permitted  to  segregate  the 
various  divisions  and  nervous  elements  so  as  to  better  un- 
derstand the  structures  with  which  we  are  dealing.  The 


104 


PRINCIPLES  OF  OSTEOPATHY 


central  nervous  system  is  constantly  receiving  impulses 
from  afferent  fibers  and  co-ordinating  them.  We  are  almost 
entirely  dependent  on  reflex  action  for  the  effects  we  secure 
on  deep  tissues.  Our  manipulations  affect  sensory  nerves  in 


Muscle  -(2tt£o 


FIG.   17.     Diagrammatic  representation  of  a  single  spinal  segment  and  a 
simple  reflex  arc.     Drawn  by  John  Comstock. 

skin,  muscle  and  synovial  membranes.  These  impulses  are 
carried  to  the  central  nervous  system  and  transformed  into 
efferent  impulses. 

Ceaseless  Play  of  Reflexes. — During  life  there  is  no 
period  when  the  body  is  not  dependent  on  external  stimuli. 
These  ordinary  mechanical  and  thermal  stimuli  keep  a  con- 
stant stream  of  impulses  entering  the  central  system  to  be 
translated  into  stimuli  of  muscle  and  gland.  This  ceaseless 


PRINCIPLES  OF  OSTEOPATHY  105 

play  of  reflexes  may  vary  in  intensity,  but  so  long  as  life 
lasts  they  are  demonstrable.  We  expect  the  reflex  to  be 
initiated  by  the  sensory  side  of  the  reflex  arc,  therefore  the 
intensity  of  muscular  contraction  and  glandular  secretion  is 
governed  by  the  intensity  of  the  initiatory  impulse. 

The  Simple  Reflex. — The  simplest  reaction  in  the  ner- 
vous system  may  be  conceived  as  a  sensory  impulse  trans- 
mitted to  the  spinal  cord  over  a  sensory  nerve  and  from  the 
cord  over  a  motor  nerve.  The  tissue  in  which  the  motor  or 
efferent  nerve  ends  will  express  reaction  to  the  stimuli  com- 
ing over  the  sensory  or  afferent  side  of  this  reflex  arc. 

The  Sensory  Side  of  the  Reflex  Arc. — The  sensory  side 
of  the  reflex  arc  is  the  one  upon  which  we  must  depend  to 
initiate  reactions.  The  segment  coordinates  the  sensory  im- 
pulses reaching  it  over  the  afferent  roots  of  its  nerve  trunks. 
By  following  the  distribution  of  its  nerves  we  can  determine 
what  cells  its  afferent  fibers  arise  in  and  what  cells  its  effer- 
ent fibers  innervate.  Taking  a  mid-dorsal  segment  we  find 
its  pair  of  nerve  trunks  dividing  and  branching  so  as  to  sup- 
ply skin,  muscle  and  viscera.  All  of  these  parts  must  have 
sensory  and  motor  fibers  and  since  our  spinal  nerves  are 
mixed  nerves,  i.  e.,  have  afferent  and  efferent  fibers,  we  know 
that  a  segment  receives  sensory  impulses  from  skin,  muscle 
and  viscera  and  the  segment  integrates  these  impulses  and 
sends  out  efferent  impulses  coordinated  for  the  best  good  of 
itself  and  the  tissues  it  innervates. 

Protective  Reactions. — A  reflex  is  primarily  a  protec- 
tive reaction.  It  is  an  effort  on  the  part  of  the  structures 
entering  into  the  reaction  to  protect  that  of  which  they  are 
a  part.  It  seems  that  the  sole  object  of  a  reflex  is  self  de- 
fense. Therefore  a  study  of  reflexes  will  tend  to  make  symp- 
tomatology far  more  interesting.  The  integration  expressed 
in  the  reactions  of  a  spinal  segment  mirror  the  manifold  re- 
lations existing  between  the  cells  which  constitute  the  ac- 
tive elements  in  a  metamere  or  body  segment.  The  seg- 
mental  structure  of  the  cord  and  the  reflex  action  manifested 
therein  show  that,  on  the  whole,  a  definite  muscle  group  and 


106  PRINCIPLES  OF  OSTEOPATHY 

a  definite  cutaneous  area  are  innervated  from  a  limited  por- 
tion of  the  central  system.  Therefore  we  may  count  on  the 
stimuli  originated  in  the  cutaneous  area  being  reflexed  to 
the  definite  muscular  area. 

Example. — An  example  in  practice  is  as  follows:  Pa- 
tient's head  is  drawn  slightly  to  the  left  side.  Complains  of 
pain  shooting  to  the  left  shoulder  and  over  the  left  clavicle 
whenever  movement  is  attempted.  History  of  exposure  to 
draught  of  cold  air.  Physical  examination  discloses  con- 
traction of  left  trapezius.  levator  anguli  scapulae  and  sca- 
leni.  Pressure  upon  these  muscles  causes  pain.  When  in- 
structed to  take  a  full  inspiration,  patient  says  he  cannot  on 
account  of  pain,  which  is  sharp  and  darting  in  character  and 
radiates  over  the  intraclavicular  portion  of  the  left  chest. 
When  we  consider  the  muscles  involved  and  the  area  of 
painful  sensations,  our  attention  is  immediately  called  to  a 
definite  segment  of  the  cord,  in  this  case  the  point  of  origin 
of  the  third  and  fourth  cervical  nerves.  The  cold  air  striking 
the  skin  intensified  the  normal  stimuli  and  the  efferent  im- 
pulses from  that  segment  of  the  cord  were  intensified  as  the 
direct  result  of  the  cutaneous  irritation.  The  point  of  irrita- 
tion, the  cutaneous  area,  governed  the  location  of  the  reflex. 
So  long  as  the  original  stimulus  was  only  moderately  inten- 
sified all  the  reflexes  emanated  from  one  segment  of  the  cord, 
but  if  they  had  been  more  intense  or  continued  longer,  we 
might  have  found  a  greater  area  reflexly  affected.  The  stim- 
uli which  would  have  reached  the  cord  would  have  been 
more  widely  diffused  above  and  below  the  point  of  entrance. 

Comparative  Segmentation. — Since  we  know  that  the 
highly  organized  spinal  cord  of  man  is  not  to  be  compared 
with  the  same  structure  in  lower  forms  of  animal  life  and 
that  segmentation  in  it  is  illy  defined,  the  practical  question 
arises  as  to  how  much  dependence  we  can  put  upon  reflexes 
in  the  human  nervous  system.  Will  the  reflexes  guide  us  to 
definite  segments  of  the  spinal  cord?  Experience  teaches  us 
that  a  thorough  knowledge  of  the  distribution  of  afferent 
and  efferent  nerves  in  man  will  interpret  reflexes  with  suffi- 


PRINCIPLES  OF  OSTEOPATHY  107 

cient  exactness  and  invariably  lead  the  investigator  to  a 
spinal  segment  which  is  itself  affected  or  is  coordinating  im- 
pulses from  a  known  sensory  area. 

Efferent  Impulses. — When  we  follow  the  efferent  im- 
pulses to  their  points  of  distribution  our  work  is  greatly 
complicated.  To  reason  from  contracted  voluntary  muscle 
to  cutaneous  sensory  area  is  a  comparatively  simple  pro- 
cedure, but  to  start  with  the  sensory  impulse  and  trace  it 
through  the  central  system  and  thence  along  efferent  path- 
ways, to  estimate  its  final  effects,  as  mechanical  work  done 
by  muscle  and  gland  in  many  combinations,  requires  a  con- 
siderable knowledge  of  structure  and  function  of  all  parts  of 
the  human  system. 

Efferent  Fibers  to  the  Sympathetic  Ganglia. — Many  of 
the  efferent  fibers  of  the  cerebro-spinal  system  take  their 
course  through  the  sympathetic  ganglia  and  are  distributed 
in  that  system  to  plain  muscle  and  secretory  cells  of  the 
body.  It  has  been  ascertained  by  various  careful  observers 
that  these  efferent  fibers,  after  entering  the  sympathetic 
system,  either  end  in  the  ganglia  nearest  their  point  of  emer- 
gence from  the  cord  or  pass  up  or  down  to  ganglia  above  or 
below  the  one  originally  entered.  Some  fibers  pass  through 
these  ganglia  and  end  in  the  more  peripherally  placed 
plexuses. 

Ganglionic  Control. — Wherever  nerve  cells  are  accumu- 
lated a  certain  amount  of  independent  action  is  probably 
carried  on.  Terminal  filaments  of  efferent  fibers  in  sympa- 
thetic spinal  ganglia  are  in  relation  with  a  large  number  of 
cells  and  the  number  of  fibers  leaving  the  ganglia  is  greater 
than  those  entering.  Therefore  diffusion  of  impulses  from 
these  ganglia  must  be  very  great.  The  accumulation  of 
sensory  impulses  in  these  ganglia  may  be  equally  as  great. 
Each  ganglion  must  have  a  dominant  influence  over  a  cer- 
tain visceral  area,  and  this  influence  is  subsidiary  to  the 
control  exercised  by  the  segment  of  spinal  cord  to  and  from 
which  the  larger  number  of  fibers  proceed. 


108 


PRINCIPLES  OF  OSTEOPATHY 


Glcmd 


Musck. 


Vessel 


FIG.    18.     Diagram   of  sensory   and   motor  fields   co-ordinated   in  a  spinal 
segment;   and   the   inhibitory  influence  of  the  brain. 


PRINCIPLES  OF  OSTEOPATHY  109 

Three  Fields  for  Reception  of  Sensory  Impressions. — 
The  three  original  layers  of  the  embryo,  epiblast,  endoblast 
and  mesoblast,  forming  skin,  mucous  membrane  and  the 
intervening  tissues,  are  represented  by  sensory  fibers  which 
connect  them  with  the  central  nervous  system.  The  outer 
surface  of  the  body  is  supplied  with  extero-ceptive,  the  in- 
ternal surface  with  intero-ceptive  and  the  intercellular  sur- 
faces with  proprio-ceptive  fibers.  The  coordination  of  these 
various  receptive  fields  is  the  duty  of  the  segment.  We  have 
reactions  in  this  segment  which  represent  the  effort  of  the 
segment  to  adapt  itself  to  external  conditions.  The  external 
surface  registers  in  the  segment  the  conditions  of  the  out- 
side world,  so  far  as  the  special  endings  of  its  sensory  nerves 
are  capable.  The  internal  surface  takes  cognizance  of  the 
presence  of  material  in  contact  with  it  which  in  most  cases 
may  serve  as  food.  Not  all  spinal  segments  have  this  vis- 
ceral division  represented  in  them. 

Proprio-ceptive  Field. — The  surface  of  the  individual 
cells,  which  compose  the  bulk  of  the  body,  are  represented 
in  the  segment  by  a  large  number  of  sensory  fibers  which 
register  their  conditions  and  needs.  This  proprio-ceptive 
field  is  an  exceedingly  large  one  and  is  usually  little  thought 
of  when  considering  the  reactions  of  the  nervous  system. 
It  is  the  proprio-ceptive  nerves  which  are  affected  in  any 
trauma  of  joints  or  other  deep  structures.  The  sense  of  po- 
sition, muscular  tension  and  weight  are  to  a  large  extent  de- 
pendent on  these  fibers. 

Segmental  Coordination. — The  segment  of  the  spinal 
cord  governing  a  metamere  receives  sensory  stimuli  from 
three  different  receptor  fields,  the  external  and  internal  sur- 
faces and  the  bulk  of  the  tissue  between  these  surfaces.  The 
harmonious  functioning  of  the  whole  segment  is  the  result 
of  the  coordination  of  all  the  impulses  from  these  three  re- 
ceptor fields,  expressed  in  effector  tissues,  muscle  and  gland. 
These  reactions  represent  the  segment's  effort  to  meet  the 
conditions  of  its  environment,  plus  its  own  inter-cellular 


110  PRINCIPLES  OF  OSTEOPATHY 

condition,  to  the  best  advantage.  In  other  words,  its  reac- 
tions represent  its  effort  to  maintain  its  existence. 

Plurisegmental  Control. — Just  as  no  skin  area,  or  mus- 
cle, other  than  a  distinctly  segmental  one,  as  mentioned  in 
Chapter  V.  no  viscus  is  wholly  under  the  influence  of  one 
segment.  Therefore  one  segment  is  merely  a  contributor  of 
a  partial  influence  over  skin,  muscle  and  internal  organ.  One 
segment  may  furnish  the  majority  of  fibers  to  a  certain  per- 
ipheral nerve,  but  complete  control  is  divided  between  two 
or  more  segments.  This  seems  to  indicate  that  physiologi- 
cal centers  in  the  spinal  cord  consist  of  series  of  cells,  placed 
vertically,  whose  fibers  thus  emerge  at  various  levels.  With 
this  fact  in  view  we  recognize  that' any  reaction  to  stimuli, 
arising  in  any  one  of  the  three  receptor  fields,  will  be  ex- 
pressed in  effector  tissues  belonging  to  at  least  two  or  more 
metameres.  Therefore  any  protective  reaction  in  spinal 
areas  will  involve  more  than  one  spinal  articulation. 

Clinical  Evidence,  Group  Lesions. — This  agrees  with 
the  clinical  findings.  Take  spinal  tenderness  for  example: 
A  point  is  usually  found  which  shows  considerable  tender- 
ness and  this  tenderness  shades  off  through  a  metamere 
above  and  below  the  most  sensitive  point.  Contraction  of  a 
spinal  muscle,  i.  e.,  of  a  portion  of  the  erector  spinae,  extends 
over  two  or  more  metameres.  Osseous  lesions  are  usually 
of  the  group  character.  The  approximation  or  separation  of 
two  spinous  processes  represents  the  involvement  of  at  least 
four  vertebrae,  i.  e.,  one  above  and  one  below  the  center  of 
the  lesion.  Likewise,  the  lateral  deviation  of  a  spinous  pro- 
cess means  the  involvement  of  three  vertebrae.  Thus  we  see 
that  all  reactions  are  practically  pluri-segmental  instead  of 
segmental.  The  vertical  arrangement  of  the  governing  cells 
in  the  spinal  cord  is  the  foundation  for  this.  Just  as  we 
noted  the  migration  of  muscles  for  purposes  of  better  guard- 
ing of  the  body,  so  also  we  note  that  segments  have  divided 
their  influence  with  adjoining  ones. 

Differentiation  of  Spinal  Lesions. — In  view  of  these 
facts  it  is  hard,  in  fact  impossible,  to  differentiate  spinal  le- 


PRINCIPLES  OF  OSTEOPATHY 


111 


5EN30BY 

|  Neck  and  scalp 
V  NecK  hnd  shoulder 

Shoulder 

Arm 

Hand 


Front  of  thorax. 
I  Xiphoid  area 


(Umbilicus,  10th) 


5uttock, 
upper  part 


\6nnn  and  scrotum 
]       .(front) 

'outer  suk 


Thigh- 


•  uluteul 

Foot  Jo1 
Plantar 


inner  s»d« 


Leg, inner  5Kle 
Buttock, 
Vouuer  part 

Bcu;k  of  thigH 

Le9\  except 
ona-f  inner  part 
footj 

Pennceum  and 
anui 


pkin  from  toccy* 
to  anus 


FIG.  19.  Diagram  and  table  showing  the  approximate  relation  to  the 
spinal  nerves  of  the  various  motor,  sensory  and  reflex  functions  of 
the  spinal  cord.  (Gowers.) 


MFLEX 


> Scapular 


•Epigustru. 


y.  Abdominal 


putt 


112  PRINCIPLES  OF  OSTEOPATHY 

sions  as  primary  or  secondary,  i.  e.,  traumatic  or  reflex, 
based  on  palpation  of  the  tissues.  The  characteristics  are 
quite  similar  because  the  protective  reactions  of  the  body, 
whether  in  response  to  stimuli  from  the  extero-,  intero-,  or 
proprio-ceptive  fields,  will  be  manifested  in  the  effector  tis- 
sues, muscle  and  gland,  of  the  pluri-segments  belonging  to 
the  receptor  fields  receiving  the  stimuli.  For  example:  Irri- 
tation of  the  skin  of  the  back  supplied  by  nerves  from  the 
segments  of  the  cord  which  have  rami-communicantes  con- 
necting with  the  renal  splanchnics,  may  produce  reactions  in 
all  the  tissues  governed  by  that  pluri-segmental  center.  A 
stream  of  cold  air  blown  on  this  skin  when  it  is  wet  would 
produce  a  pronounced  reaction.  Likewise,  a  counter-irritant 
would  produce  a  reaction.  In  the  case  of  the  reaction  to  cold 
the  muscles  under  this  skin  area  would  contract.  There 
would  be  lost  motion  in  the  vertebral  articulations  of  these 
metameres  due  to  the  hypertension  of  the  muscles.  Sensi- 
tiveness to  pressure  and  a  feeling  of  lameness  would  de- 
velop. The  probabilities  are  that  the  kidneys  would  show 
marked  change  in  function.  We  have  kept  our  reactions 
thus  far  in  the  metameres  whose  cutaneous  surfaces  are  af- 
fected, but,  clinically,  we  know  such  a  condition  as  this  is 
serious  and  hence  the  whole  fighting  power  of  the  body  is 
called  upon  to  protect  it  from  this  high  tension  in  a  series 
of  important  metameres. 

Lesions  Due  to  Functional  Fatigue. — Let  us  reverse  the 
picture  and  start  with  a  functional  disturbance  of  the  kid- 
neys due  to  too  great  demands  on  them  in  eliminating  nitrog- 
enous waste  material.  This  functional  fatigue  might  pro- 
duce muscular  contraction,  pain  or  tenderness  in  the  spinal 
areas  associated  by  innervation,  i.  e.,  the  pluri-segmental 
areas,  and  thus  duplicate  all  the  phenomena  mentioned  in 
our  previous  description.  The  field  of  proprio-ceptive  im- 
pressions, that  is  the  structural  tissues  in  this  particular 
pluri-segmental  field,  may  likewise  be  the  point  at  which  all 
these  reactions  are  initiated.  Injury,  or  functional  fatigue, 
as  is  seen  in  street  car  men  whose  backs  suffer  from  the  con- 


PRINCIPLES  OF  OSTEOPATHY  113 

stant  vibration  of  the  cars,  will  set  up  reactions  which,  so 
far  as  palpation  is  concerned,  show  physical  signs  similar  to 
the  two  preceding.  After  noting  the  physical  signs,  of  a 
pluri-segmental  character,  it  is  evidently  necessary  to  go 
much  farther  into  symptomatology  in  order  to  differentiate 
the  primary  from  the  secondary  lesion.  Since  the  body  func- 
tions as  a  whole  no  limited  pluri-segmental  reactions  con- 
tinue without  other  portions  of  the  body  enter  the  contest 
for  the  preservation  of  the  whole.  In  the  example  just  given 
the  contraction  of  somatic  muscles,  tension  in  skin  and  kid- 
ney consequent  on  the  influence  of  the  cold  air,  is  a  condition 
prejudicial  to  the  life  of  the  body  because  elimination  is 
greatly  decreased  and  hence,  unless  compensatory  elimina- 
tion can  be  established,  autointoxication  of  a  fatal  type  will 
supervene.  We  may  conceive  of  an  elimination  center  in 
the  nervous  system  represented  by  a  column  of  cells  extend- 
ing throughout  the  cord,  controlling  in  all  metameres  the 
sweat  function  of  the  skin  and  in  those  metameres  asso- 
ciated with  the  bowels  and  kidneys,  the  special  functions  of 
these  organs.  We  know  all  these  means  of  elimination  are 
coordinated  and,  in  case  of  need,  strongly  compensatory. 
The  bowels  must  be  urged  to  compensate  for  the  failure  of 
skin  and  kidney  elimination.  Elimination  may  fail  so  quick- 
ly and  completely  that  the  consequent  autointoxication  and 
high  arterial  tension  strain  the  heart.  A  new  group  lesion 
representing  this  organ  becomes  apparent,  and,  to  the  phy- 
sician who  studies  the  case  for  the  first  time,  at  this  stage 
offers  difficulties  of  analysis  almost  insurmountable.  The 
spinal  lesions  mirror  the  compensatory  reactions  of  the 
body.  They  are  guides  to  an  understanding  of  the  symp- 
tom complex  presented  in  any  case  of  disease  and  if  studied 
coordinately  with  the  symptoms  often  lead  the  mind  of 
the  physician  logically  to  the  origin  of  the  disease  reactions. 


114  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  VII. 

THE  NERVOUS  SYSTEM  (Continued). 

Alignment,  Tone,  Reflexes. — Osteopaths  have,  to  some 
extent,  discarded  subjective  symptoms,  believing  that  they 
are  of  very  doubtful  value  in  the  large  proportion  of  patients. 
Having  discarded  subjective  symptoms,  they  have  developed 
a  method  which  gives  equal  or  better  results.  It  has  three 
phases,  two  of  which  are  structural  and  one  which  is  partial- 
ly subjective.  First  in  order  comes  skeletal  alignment;  sec- 
ond, muscular  tone;  third,  condition  of  reflexes.  These 
three  divisions  all  come  under  the  general  head  of  palpation. 

Clinical  Illustration. — As  an  illustration  of  the  value  of 
objective  in  preference  to  subjective  symptoms,  the  follow- 
ing case  is  of  considerable  value.  The  gentleman  whose 
physical  condition  is  practically  illustrated  in  Figs.  20  and  21 
was  examined  in  the  clinic  of  the  Pacific  College  of  Osteo- 
pathy. He  has  been  operated  on  surgically  for  a  peculiar 
enlargement  just  above  and  external  to  the  right  knee  .  The 
line  of  the  incision  is  shown  in  Fig.  20.  He  stated  that  he 
had  suffered  pain  at  this  point  during  more  than  a  year,  and 
his  physician  had  decided  that  there  was  a  tuberculous  con- 
dition of  the  bone.  The  operation  did  not  confirm  this  diag- 
nosis. Xo  unhealthy  tissue  was  found. 

Inspection. — \\e  noted  his  peculiar  handling  of  the  leg 
when  walking,  compared  both  limbs  from  toe  to  hip  and 
discovered  a  marked  difference  in  size,  as  is  indicated  in  the 
photograph.  By  following  the  course  of  the  nerves  to  the 
spinal  column,  we  discovered  that  the  muscles  on  the  right 
side  of  the  spine  were  atrophied  in  proportion  to  those  of 
the  extremity.  Fig.  21  shows  the  fact  that  the  atrophied 


PRINCIPLES  OF  OSTEOPATHY 


115 


FIG.  20.  Case  illustrating  atrophy  of  the  muscles  of  the  right 
leg  due  to  faulty  trophic  influence  of  the  nerve  cells  in  the 
spinal  cord.  The  scar,  just  above  the  right  patella,  is  su- 
perficial to  a  hypertrophic  condition  of  the  bone. 


116 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    21.     General   view    of    case    illustrated    in    the 
•    preceding     figure.       The     spinal     curvature     is 
clearly    indicated.      Pateiiar    tendon    reflex    ab- 
sent on  right  side  but  present  on  the  left. 


PRINCIPLES  OF  OSTEOPATHY  117 

condition  extends  into  the  interscapular  region,  and  the 
spinal  column  is  bent. 

Patellar  Tendon  Reflex. — The  patellar  tendon  reflex  was 
lost  on  the  right  side,  but  present  on  the  left.  The  right  leg 
was  ataxic,  but  the  left  leg  was  normal,  thus  presenting 
what  might  be  called  a  unilateral  locomotor  ataxia.  If  this 
man's  surgeon  had  taken  the  care  to  examine  him  from  an 
objective  structural  standpoint  rather  than  to  depend  on  the 
subjective  symptoms,  it  is  highly  probable  that  no  opera- 
tion would  have  been  performed.  Our  examination  demon- 
strated that  this  man's  structural  condition  was  at  fault  and 
that  the  trophic  influence  of  a  part  of  his  nervous  system 
was  being  gradually  lost.  Both  the  motor  and  sensory 
nerves  were  acting  feebly. 

Gastric-spinal  Reflex. — It  might  be  asked,  "How  could 
one  secure  a  spinal  reflex  from  the  stomach?"  In  what  way 
would  the  finding  of  such  a  reflex  surpass  ordinary  methods 
of  examination?  The  neurologist,  when  making  examina- 
tion of  a  patient  suffering  with  some  condition  of  the  sen- 
sory or  motor  portion  of  the  nervous  system,  must  possess 
a  definite  knowledge  of  the  origin,  course  and  distribution  of 
nerve  trunks  in  order  to  locate  accurately  the  position  of  the 
lesion.  The  osteopath  pursues  the  same  method  of  exam- 
ination, but  follows  it  farther.  His  investigation  takes  into 
consideration  the  dispersion  of  efferent  fibers  in  the  sympa- 
thetic system  and  the  sensory  impulses  received  by  the 
spinal  cord  from  that  system. 

Sensation. — Edinger  quotes  Exner  as  follows :  "One 
must  not  suppose  that  all  the  impulses  reaching  the  spinal 
cord  by  the  sensory  roots  are  identical  with  what  is  ordi- 
narily called  'sensation.'  In  order  that  an  impression  be 
perceived,  it  is  not  sufficient  that  it  be  conducted  to  the 
spinal  cord,  but  it  must  be  farther  carried  up,  from  the  place 
where  the  peripheral  part  ends  to  the  cerebral  cortex.  There 
is,  however,  no  doubt  at  all  that  all  these  higher  connections 
are  few  in  number,  and  that  contrasted  with  the  multitude  of 
fibers  in  the  posterior  roots,  the  number  of  such  cranial  con- 


118  PRINCIPLES  OF  OSTEOPATHY 

nections  is  quite  small.  This  alone  makes  the  conclusion 
possible  that  there  are,  indeed,  many  sensory  impressions 
which  arrive  at  the  spinal  cord,  but  that  we  are  aware  of  but 
few  of  them  at  the  time.  All  the  viscera  of  the  body,  as  the 
staining  method  has  distinctly  shown,  are  traversed  by  an 
altogether  unexpectedly  large  number  of  nerves  and  their 
arrangement  and  course,  their  relations  to  blood  vessels  and 
glands,  and  to  muscle  fibers,  bones  and  enamel,  makes  it 
more  than  probable  that  there  is,  in  this  connection,  a  large 
system  which  serves  essentially  to  regulate  impressions  and 
reflex  action." 

Visceral  Sensation. — It  is  the  reflexes  mentioned  in  this 
quotation  in  which  we  are  interested.  Sensation  and  per- 
ception are  dissimilar.  Sensations  from  the  viscera  are  co- 
ordinated in  fairly  well  marked  areas  of  the  spinal  cord  and 
when  these  sensory  impressions  are  intense  the  efferent 
fibers  of  the  spinal  cord  manifest  the  condition  existing  in  a 
visceral  area  by  causing  an  abnormal  condition  of  muscular 
tone  in  the  intrinsic  muscles  of  the  back.  This  contractured 
condition  of  the  muscles  is  not  the  only  evidence  of  the  vis- 
ceral reflex.  Pressure  on  the  contracted  muscle  causes  pain. 
The  intensity  of  the  aesthesia  is  usually  in  proportion  to  the 
visceral  irritation.  Even  though  the  patient  does  not  say 
in  so  many  words  that  there  is  pain  on  slight  pressure,  the 
examiner,  if  his  palpation  is  good,  can  detect  the  reflex  in  the 
action  of  the  muscle. 

Dependence  on  Objective  Symptoms. — A  patient  comes 
to  an  osteopath  desiring  to  be  examined.  He  does  not  vouch- 
safe any  information  as  to  his  condition,  merely  saying: 
"I  want  you  to  examine  me  and  find  out  what  is  the  matter 
with  me."  This  is  a  challenge  to  the  skill  of  the  examiner 
and  calls  for  something  besides  a  long-distance  catechising 
as  to  subjective  feelings.  The  osteopath  proceeds  with  ab- 
solute precision  to  determine  the  condition  of  his  patient's 
structural  formation — (1)  skeletal  alignment,  (2)  muscu- 
lar tone,  and  (3)  segmental  spinal  reflex.  Each  yields  valu- 
able information.  The  examiner's  fingers  may  develop  a  re- 


PRINCIPLES  OF  OSTEOPATHY  119 

flex  around  the  sixth  dorsal  spine.  This  is  noted  as  a  reflex 
from  the  gastric  area.  Testing  the  segments  above  and  be- 
low, this  will  show  how  great  a  section  of  the  cord  is  irri- 
tated and  will  be  an  indication  of  the  extent  of  the  internal 
irritation,  i.  e.,  whether  other  portions  of  the  digestive  tract 
are  affected.  The  reflex  might  extend  as  far  as  the  fourth 
dorsal  and  still  indicate  the  gastric  area.  Finding  the  reflex 
at  the  sixth  dorsal  spine  has  directed  the  attention  of  the 
examiner  to  the  gastric  area  and  has  located  a  point  from 
which  further  examination  is  to  proceed.  Percussion  over 
the  stomach  would  reveal  other  facts,  and  then  the  examina- 
tion would  be  pursued  along  general  lines  of  physical  diag- 
nosis to  determine  the  character  of  the  gastric  disorder.  The 
moment  the  examiner  centers  his  examination  on  the  stom- 
ach, the  confidence  of  the  patient  is  assured.  Is  not  this 
confidence  greatly  to  be  desired  in  every  case?  Is  it  not  a 
force  which  compels  the  patient  to  follow  the  directions  of 
his  physician  in  matters  of  diet  and  hygiene?  In  this  exam- 
ple we  have  illustrated  the  attributes  of  nerve  tissue,  (1) 
irritability,  (2)  conductivity.  Other  conditions  which  make 
this  illustration  possible  are  (1)  muscular  contraction  in  re- 
sponse to  nerve  stimulation,  (2)  segmentation  of  the  spinal 
cord,  (3)  reflex  action. 

Depth  and  Extent  of  Lesions. — From  the  clinical  stand- 
point lesions  may  be  classified  somewhat  according  to  depth 
and  extent;  for  example,  the  lesions  which  are  due  to  trauma 
of  somatic  tissues,  involving  one  spinal  articulation,  would 
be  deep  and  as  soon  as  the  patient  is  placed  in  a  position  of 
rest,  the  extent  of  the  muscular  contraction  would  greatly 
decrease.  This  is  not  the  case  when  the  lesion  is  due  to  a 
visceral  irritation.  The  viscus  has  a  pluri-segmental  con- 
nection with  the  nervous  system  and  hence  the  contraction 
of  muscles  in  the  spinal  area  is  usually  of  greater  extent. 
The  position  of  rest,  i.  e.,  reclining,  does  not  usually  cause 
the  muscles  to  relax.  This  shows  that  the  contraction  is  not 
a  normal  effort  to  maintain  the  upright  position  but  a  hyper- 
tension due  to  visceral  disturbance. 


120  PRINCIPLES  OF  OSTEOPATHY 

Lesion  Picture  in  Autotoxemia. — As  soon  as  we  have  an 
autotoxemia  to  deal  with  our  lesion  picture  is  greatly  en- 
larged. This  is  well  illustrated  in  the  various  manifestations 
of  indigestion.  In  such  cases,  not  only  lesions  in  the  areas 
segmentally  associated,  but  also  above  and  below,  will  be 
found.  Some  cases  will  complain  of  the  whole  length  of  the 
spine  while  the  autointoxication  is  at  its  height.  As  the  in- 
tensity of  the  autointoxication  decreases  the  lesion  areas 
become  restricted  to  the  physiologically  associated  spinal 
areas.  This  is  true  in  the  infections  as  well.  The  backache 
in  tonsilitis,  la  grippe,  smallpox,  etc.,  are  well  known  and 
evidently  not  located  in  physiologically  associated  areas. 
The  phenomena  of  spinal  hypertension  and  hyperaesthesia 
are  very  prominent  in  these  cases.  Nothing  seems  to  palliate 
this  spinal  condition  due  to  toxemia  to  the  same  extent  as 
manipulation.  We  say  palliate  because  the  toxemia  which 
causes  the  tension  is  not  overcome  by  relieving  the  spinal 
tension. 

Lesions  Independent  of  Segmental  Reflexes. — As  soon 
as  we  find  lesions  that  seem  to  have  arisen  independently  of 
what  we  can  readily  recognize  as  segmental  reflexes,  they 
must  be  explained  on  the  basis  of  some  integration  of  the 
body  other  than  nervous.  This  is  the  case  in  the  toxemias. 
The  circulating  media  are  the  integrating  factors  which  ex- 
plain the  backache  as  well  as  many  other  aches  in  those 
cases  where  there  is  no  visceral  involvement  which  may 
reasonably  be  associated  with  them.  Increasing  elimination 
will  usually  correct  these  spinal  lesions  due  to  toxemia. 

The  Lesion  as  an  Expression  of  Some  Form  of  Integra- 
tion.— Any  spinal  lesion  may  be  analyzed  from  several 
standpoints,  because  it  may  be  a  partial  expression  of  one  or 
more  integrating  factors  of  the  body,  i.  e.,  the  structural, 
circulatory  or  nervous.  The  traumatic  lesion  shows  itself 
subject  to  position,  i.  e.,  can  be  rested  and  lessened  by  a 
position  which  mechanically  lessens  the  strain.  The  lesion 
due  to  nervous  integration  is  not  so  quickly  relieved  by  the 
means  which  relieve  the  traumatic  lesion.  The  fact  that  it 


PRINCIPLES  OF  OSTEOPATHY  121 

is  a  reflex  presupposes  an  adequate  point  of  irritation  else- 
where. This  point  must  be  located  before  the  lesion  is  ade- 
quately relieved.  This  is  well  illustrated  in  the  reflexes  in 
the  mid-dorsal  area  due  to  fermenting  food  in  the  stomach. 
Emptying  the  stomach  relieves  the  lesion. 

Circulatory  Integration  Lesion. — The  lesion  due  to  cir- 
culatory integration  is  hard  to  recognize  because  one  nat- 
urally thinks  of  the  other  forms  of  integration  and  attempts 
to  square  his  findings  with  these  forces.  Then  also  the  cir- 
culatory integration  is  largely  under  the  direct  influence  of 
the  nervous  system.  It  is  a  good  plan  to  analyze  lesions  first 
on  a  basis  of  structural  integration,  then  nervous  and  finally 
circulatory.  This  evolutionary  method  of  following  a  nat- 
ural plan  helps  to  keep  ones  mind  working  in  a  logical 
manner. 

Protective  Reactions. — The  protective  reactions  of  the 
body  are  not  all  segmental  nor  even  within  small  groups  of 
segments.  So  long  as  they  are  purely  segmental  we  are 
reasonably  certain  that  the  condition  is  not  constitutional 
because  a  constitutional  ailment  involves  the  whole  fighting 
power  of  the  body  to  such  an  extent  that  the  clinician  readily 
recognizes  the  seriousness  of  the  situation.  Take  for  in- 
stance the  progressive  involvement  of  lung  tissue  in  tuber- 
culosis. The  early  stages  of  the  disease  may  show  very  lit- 
tle or  no  constitutional  symptoms  such  as  chill,  fever,  sweat 
and  loss  of  flesh.  At  this  time  somewhere  in  the  interscap- 
ular  area  will  appear  a  lesion,  muscular  contraction  and 
tenderness  to  digital  pressure.  This  lesion  is  not  distinctive 
of  pulmonary  tuberculosis  any  more  than  of  any  other  ir- 
ritation in  its  associated  visceral  area.  It  merely  indicates 
the  segment  or  segments  involved  in  the  circulatory  dis- 
turbance characterized  by  the  congestion  in  the  infected 
area.  As  the  pulmonary  lesion  envolves  larger  areas  the 
spinal  lesion  grows  proportionately.  This  is  probably  true 
except  when  the  pleura  is  inflamed.  Then  we  have  a  pro- 
tective rigidity  of  a  vastly  more  pronounced  character. 
As  soon  as  effusion  takes  place  the  intensity  of  the  rigidity 


122  PRINCIPLES  OF  OSTEOPATHY 

lessens  because  pain  is  lessened.  As  soon  as  the  tubercu- 
lar process  shows  constitutional  symptoms  the  spinal  lesion 
picture  varies  from  morning  to  night,  that  is,  fluctuates 
with  the  varying  intensity  of  the  disease  reactions.  The 
positive  and  negative  phases  of  the  body's  reactions  are 
reflexly  evidenced  in  the  spinal  areas.  As  the  disease  pro- 
gresses and  areas  of  pulmonary  tissues  are  lost  or  fibrous 
tissue  formed,  with  consequent  lessening  in  antero-pos- 
terior  diameter  of  the  chest  and  decreased  amplitude  of 
the  respiratory  movements,  lesions  of  a  structural  char- 
acter appear  in  the  spinal  area,  such  as  flattening  of  the 
dorsal  curve  and  elevation  of  the  angles  of  the  ribs  caused 
by  the  rotation  downward  of  the  anterior  extremities  of 
the  ribs  in  the  flattening  of  the  chest.  The  change  in  the 
chest  causes  a  change  in  the  tension  of  the  scaleni  muscles 
in  the  neck  and  in  case  only  one  pulmonary  apex  is  in- 
volved there  is  unequal  tension  in  the  scaleni  of  the  two 
sides  of  the  neck,  thus  causing  the  extensors  of  the"  neck 
to  exert  a  compensatory  action.  The  change  in  cervical 
vertebral  alignment  and  muscular  tension  constitutes  in 
this  instance  a  spinal  lesion  which  is  properly  compensa- 
tory and  therefore  not  helped  by  corrective  movements. 
Many  such  lesions,  profoundly  compensatory  in  character, 
should  receive  no  direct  corrective  manipulation.  Since 
they  are  dependent  upon  tissue  involvement  elsewhere  we 
must  make  our  diagnosis  from  cause  to  effect  in  order  to 
get  our  therapeutics  in  right  sequence. 

Pains  Incident  to  Chill  and  Fever. — The  headache, 
neckache,  backache  and  legache  of  chill  and  fever  are  sub- 
jective symptoms  prominent  in  a  host  of  cases.  These 
symptoms  are  of  varying  intensity  but  even  when  not  com- 
plained of,  a  tenderness  in  the  neck  and  back  is  readily 
elicited  by  digital  pressure.  As  the  fever  subsides  these 
areas  of  sensitiveness  to  pressure  grow  less  and  less,  show- 
ing that  their  great  extent  in  the  beginning  is  a  constitu- 
tional condition.  It  is  readily  recognized  that  our  spinal 
lesion  in  pulmonary  tuberculosis  has  changed  with  each 


PRINCIPLES  OF  OSTEOPATHY  123 

phase  of  the  disease.  This  is  probably  true  of  all  diseases, 
hence  there  is  no  fixed  lesion  associated  with  any  visceral 
or  somatic  disease.  A  slightly  varying  set  of  reactions 
accompanies  each  disease  process.  These  reactions  are 
usually  true  to  type  but  not  capable  of  classification  ex- 
cept in  a  general  way.  ,The  organs  of  the  body  are  inner- 
vated from  fairly  definite  areas  of  the  cord  and  we  speak 
of  these  as  nerve  centers,  but  as  before  stated  these  cen- 
trs  consist  of  cells  placed  vertically  and  extending  through 
several  segments.  The  spinal  lesions  found  in  visceral 
disease  are  hence  pleuri-segmental  and,  if  there  is  toxemia, 
there  is  a  set  of  lesions  expressive  of  this  condition  super- 
imposed on  the  first,  then,  in  case  of  destruction  of  tissue, 
compensatory  changes  in  structure  are  noticeable.  The 
three  major  forms  of  integration  are  involved  in  any  severe 
illness  and  hence  the  diagnostician  must  try  to  separate 
the  various  evidences  of  the  body's  protective  reactions. 
The  greater  variation  will  be  in  those  symptoms  due  to 
circulatory  integration.  This  is  evidenced  by  the  rapid 
changes  in  cases  of  autointoxication.  The  lesion  which  is 
characterized  by  its  persistence  will  be  located  in  that  seg- 
ment or  segments  most  closely  allied  with  the  center  of 
visceral  disturbance.  The  lesion  of  still  more  permanence 
will  be  the  primarily  traumatic  or  secondarily  compensa- 
tory. 

The  Practical  Use  of  Knowledge.  —  We  have  added 
nothing  new  to  the  world's  knowledge  of  nerve  tissue,  but 
we  have  applied  general  knowledge  of  this  tissue  to  specific 
uses.  We  have  taken  the  results  of  laboratory  experiments 
and  made  them  practical  methods  in  the  detection  and 
alleviation  of  disease.  It  appears  to  us  that  sufficient  re- 
search work  has  been  done  on  the  nervous  system  by  med- 
ical men  and  sufficient  general  conclusions  drawn  from 
their  investigations  to  justify  all  branches  of  the  profession 
in  making  more  extensive  use  of  such  data.  The  correla- 
tion of  laboratory  data  with  the  results  of  clinical  experi- 
ence make  the  foundation  of  osteopathic  diagnosis  at  the 


124  PRINCIPLES  OF  OSTEOPATHY 

present  time.  By  this  bold  application  of  knowledge, 
which  by  the  medical  profession  at  large  has  been  regarded 
as  speculative  and  at  least  impracticable,  osteopathy  has 
gained  an  impregnable  position  in  the  healing  arts. 

Laboratories  make  scientists,  not  physicians;  hence 
physicians  have  not  always  grasped  the  full  significance 
of  the  scientific  discoveries  in  physiology  and  applied  them 
to  therapeutics. 

Whatever  osteopathy  may  at  present  possess  or  gain 
in  the  future,  is  due  solely  to  a  close  adherence  to  the  facts 
of  anatomy  and  physiology;  and  the  application  of  these 
fundamental  facts  to  scientific  therapeutics. 


PRINCIPLES  OF  OSTEOPATHY  125 


CHAPTER  VIII. 

THE  SYMPATHETIC  NERVOUS  SYSTEM. 

Unity  of  the  Nervous  System. — It  gives  a  wrong  im- 
pression to  speak  of  the  cerebro-spinal  nervous  system  and 
the  sympathetic  nervous  system  as  though  they  are  inde- 
pendent of  each  other.  They  are  parts  of  a  single  system. 
They  make  all  parts  of  the  body  intercommunicative,  and 
make  it  possible  for  a  slight  stimulus  to  cause  a  widespread 
response.  They  convey  all  impulses  of  a  sensory  character 
to  the  central  nerve  cells  and  cause  internal  activity  and  re- 
sponse to  external  stimuli.  In  fact,  the  harmonious  action 
of  the  tissues  in  our  body  depends  on  every  cell  knowing  the 
condition  of  every  other  cell.  Each  cell  is  capable  of  perfect 
life  only  so  long  as  it  is  able  to  communicate  with  the  cen- 
tral nervous  system,  ready  to  give  and  to  receive,  thus  ful- 
filling the  law  of  reciprocity. 

For  convenience  of  description,  the  nervous  system  is 
divided  into  the  cerebro-spinal  and  the  sympathetic.  We 
have  already  said  that  these  are  parts  of  one  whole.  They 
are  continuous  anatomically  and  physiologically.  In  the  at- 
tempt to  write  of  them  separately,  we  desire  you  to  bear 
constantly  in  mind  their  interdependence. 

"The  dependence  and  independence  of  the  cerebro- 
spinal  and  sympathetic  systems  of  nerves  may  be  compared 
to  the  State  and  Federal  Governments,  or  the  Municipal  and 
State  Governments.  The  former  run  in  harmony,  when 
friction  does  not  arise,  yet  the  State  lives  quite  a  distinct, 
individual  life — quite  independent  of  the  Federal  Govern- 
ment. And  the  life  of  each  is  dependent,  however,  on  the 
other.  The  internal  life  of  each  (as  of  the  sympathetic) 


126 


PRINCIPLES  OF  OSTEOPATHY 


Phorynx. 


Pancreas. 
Small  Intestine 
Large  Intestine 


Hypo4ostric 
Plexus 


FIG.   22.     Schematic   representation   of  the  connections  between 
the  sympathetic  and  cerebro-spinal  nervous  systems. 


PRINCIPLES  OF  OSTEOPATHY  127 

maintains    itself." — Byron    Robinson    in    the    "Abdominal 
Brain,"  page  55. 

Origin. — The  sympathetic  appears  to  originate  from  the 
ganglia  on  the  posterior  roots  of  the  spinal  nerves.. 

(1)  Lateral  Ganglia. — The  substance  of  the  sympthetic 
is  conveniently  divided  into  four  portions:  (1)  The  lateral 
chains  of  ganglia,  placed  one  on  each  side  of  the  vertebral 
column.    The  chains  are  connected  above  by  the  Ganglion  of 
Ribes   (French,   1800-1864),  situated  on  the  anterior  com- 
municating artery,  and  joined  below  by  the  Ganglion  Im- 
par  situated  on  the  anterior  surface  of  the  coccyx.     These 
chains   of   ganglia   are   connected   with    the    cerebro-spinal 
nerves  by  well  marked  cords. 

(2)  Four  Prevertebral  Plexuses. — The  next  prominent 
aggregations  of  nerve  tissue  are  the  great  prevertebral  plex- 
uses situated  ventral  to  the  bodies  of  the  vertebrae.     The 
first,  or  Pharyngeal,  is  situated  around  the  larynx.     The 
second,   or   Cardio-Pulmonary    Plexus,    lies   in   the   thorax. 
The  third,  or  Solar  Plexus,  encircles  the  Coeliac  Axis  and 
superior  mesenteric  artery.  The  fourth  is  the  Pelvic  Plexus, 
which  governs  the  generative  organs  and  rectum. 

(3)  Visceral  Ganglia. — The  third  part  of  the  sympa- 
thetic tissue  is  composed  of  those  ganglia  placed  between 
the  coats  of  viscera,  and  called  the  peripheral  apparatus  or 
"Automatic  Visceral  Ganglia."    (Robinson.) 

(4)  Communicating  Fibers. — All  of  these  ganglia  and 
plexuses  are  intimately  connected  with  each  other  by  nu- 
merous nerve  fibers.     These  four  parts  constitute  what  is 
commonly  known  as  the  sympathetic  nervous  system.    The 
nerve  fibers  in  the  sympathetic  system  consist  of  both  the 
medullated  and  non-medullated  varieties,  i.  e.,  white  and 
gray.     It  is  commonly  believed  that  the  white  are  cerebro- 
spinal  and  the  gray  are  sympathetic  fibers,  though  whether 
they  belong  to  the  one  or  the  other  system  cannot  be  told  by 
appearance  alone.     Function  must  also  be  considered.    The 
fibers  in  the  sympathetic  system  are  principally  of  the  non- 


128  PRINCIPLES  OF  OSTEOPATHY 

medullated  variety ;  hence,  gray  fibers  are  called  sympa- 
thetic. 

White  Rami-communicantes. — The  chains  of  the  lateral 
ganglia  are  connected  with  the  spinal  nerves  serially  by  two 
distinct  nerve  bundles  to  each  ganglion.  These  bundles  are 
called  rami-communicantes,  and  are  composed  of:  (1)  A 
bundle  of  white  or  cerebro-spinal  fibers  passing  from  the 
anterior  and  posterior  roots  of  the  spinal  nerves  to  the  gan- 
glion.'in  which  a  few  fibers  may  end;  but  the  majority  pass 
on  to  be  distributed  to  the  prevertebral  plexuses,  thereby 
giving  direct  communication  between  viscera  and  the  spinal 
cord.  These  white  fibers  consist  of  both  motor  and  sensory 
fibers.  The  white  rami-communicantes  leave  the  spinal 
cord  between  the  second  dorsal  and  second  lumbar  verte- 
brae only.  Many  of  the  fibers  are  demedullated  in  the  lat- 
eral ganglia;  others  retain  their  sheaths  as  far  as  the  pre- 
vertebral plexuses,  where  they  also  become  demedullated. 
The  cervical  region  has  no  white  rami-communicantes. 

Distribution. — The  nerves  in  the  sacral  region  which 
correspond  to  white  rami-communicantes,  pass  to  the  viscera 
without  entering  the  sympathetic  ganglia.  We  may  sum- 
marize what  we  have  written  concerning  the  endings  of  the 
white  rami-communicantes  as  follows:  (1)  End  in  the  lat- 
eral ganglia.  (2)  Pass  through  lateral  ganglia  and  end  in 
prevertebral  plexuses.  (3)  Split  up  before  entering  lateral 
ganglia  and  send  some  fibers  to  the  ganglia,  others  to  gan- 
glia above  and  below,  after  passing  into  its  own  ganglia. 

Function. — The  white  rami-communicantes  have  many 
functions,  and  these  can  be  determined  by  a  close  study  of 
distribution  and  physiological  action.  The  functions  may 
be  tabulated  approximately  as  follows :  First,  it  has  been 
demonstrated  that  vaso-constrictors  pass  out  of  the  cord  be- 
tween the  second  dorsal  and  second  lumbar  vertebrae ;  sec- 
ond, cardiac  augmentors,  ending  in  the  lower  cervical  gan- 
glia and  first  thoracic  ganglion  ;  third,  motor  fibers  to  the 
plain  muscles  of  the  intestines;  fourth,  motor  fibers  to  the 
sphincter  of  the  iris  leave  the  cord  at  the  third  dorsal  and 


PRINCIPLES  OF  OSTEOPATHY  129 

ascend  in  the  chain  of  sympathetic  ganglia;  fifth, ^inhibitory 
fibers  to  the  viscera;  sixth,  sensory  fibers  from  viscera. 

In  other  words,  it  may  be  tabulated  as  follows :  The  ab- 
dominal splanchnics  contain  viscero-motor  and  viscero-in- 
hibitory,  vaso-constrictor,  vaso-dilator  and  sensory  fibers, 
which  are  white  rami-communicantes.  Since  no  white  rami- 
communicantes  leave  the  cord  above  the  second  dorsal  or 
below  the  second  lumbar,  the  cardiac  augmentors  and  the 
constrictors  to  the  sphincter  of  the  iris  probably  leave  the 
cord  as  white  rami-communicantes  in  the  dorsal  region. 

We  have  thus  far  considered  only  those  fibers  which 
are  supposed  to  originate  in  the  cerebro-spinal  system;  at 
least,  they  are  medullated  nerves,  and  hence  are  considered 
cerebro-spinal  in  character. 

As  we  have  previously  stated,  the  bond  of  union  be- 
tween the  sympathetic  and  cerebro-spinal  systems  consists 
of  a  white  and  gray  bundle. 

Gray  Rami-Communicantes. — These  gray  fibers  are 
non-medullated  and  originate  in  the  lateral  ganglia,  being 
axis  cylinder  processes  of  nerve  cells  in  those  ganglia,  pass- 
ing thence  to  the  spinal  nerves  and  spinal  cord. 

Distribution. — They  pass  first  to  the  anterior  primary 
divisions  of  the  spinal  nerves  and  continue  with  them  to 
their  distributive  area ;  or  they  may  pass  to  the  distribution 
area  of  the  posterior  division,  to  the  distribution  area  of  the 
recurrent  branch  of  the  spinal  nerve,  and  to  the  structures 
(dura)  surrounding  the  posterior  root  of  the  spinal  nerve 
and  to  the  spinal  cord. 

Function. — Since  the  function  of  the  sympathetic  sys- 
tem is  to  control  the  caliber  of  blood  vessels,  the  plain  mus- 
cle fibers,  and  the  action  of  the  secretory  and  excretory 
glands,  we  may  state  the  function  of  these  gray  rami-com- 
municantes to  be  as  follows:  (1)  Vaso-motor  to  the  blood 
vessels  of  the  skin  and  skeletal  muscles  in  the  area  of  dis- 
tribution of  spinal  nerves ;  also  secretory  to  the  sweat  glands 
and  motor  to  the  plain  muscle  controlling  the  hairs;  (2) 
vaso-motor  to  the  blood  vessels  in  the  spinal  cord  and  its 


130  PRINCIPLES  OF  OSTEOPATHY 

membranes.  The  nerves  passing  from  the  lateral  ganglia  to 
the  prevertebral  plexuses,  therefore,  contain  white  and  gray 
fibers  having  the  functions  of  the  sympathetic  and  cerebro- 
spinal  systems,  and  from  these  prevertebral  plexuses  fibers 
pass  to  the  distal  ganglia  in  the  walls  of  the  viscera.  Thus 
we  see  that  all  the  ganglia  of  the  sympathetic  are  closely 
connected  with  the  cerebro-spinal.  These  ganglia  demedul- 
late  the  spinal  nerves  which  enter  them,  and  more  fibers 
leave  the  ganglia  than  enter  them.  These  ganglia  have  a 
trophic  influence  over  the  nerves  which  pass  from  them  to 
the  periphery.  They  are  reflex  centers. 

Functions  of  the  Sympathetic  System. — "In  general  it 
may  be  said  that  the  sympathetic  presides  over  involuntary 
movements,  nutrition  and  secretion,  holds  an  important  in- 
fluence over  temperature  and  vaso-motor  action,  and  is  en- 
dowed with  a  dull  sensibility."  (Robinson's  "Abdominal 
Brain.") 

Independent  or  Dependent. — Whether  the  action  of  the 
sympathetic  is  independent  or  dependent  is  no  longer  sub- 
ject for  experiment  and  discussion.  You  have  seen  the 
heart  beat  after  extirpation  from  the  body ;  also  the  ver- 
micular motion  of  the  intestines.  These  are  offered  as  evi- 
dences of  independent  action,  but  it  must  be  borne  in  mind 
that  under  normal  conditions  the  cerebro-spinal  nerves  can 
influence  these  activities,  either  repressing  or  augmenting 
them. 

Ganglia. — The  ganglia  of  the  sympathetic  contain  (a) 
nerve  cells,  (b)  afferent  fibers,  (c)  efferent  fibers — and  are 
therefore  governing  centers.  They  are  able  to  receive  sen- 
sation and  transform  this  into  motor  impulses,  and  hence 
are,  in  a  measure,  independent. 

Cervical  Ganglia  of  Importance  to  Osteopaths. — The 
cervical  portion  of  the  gangliated  cord  contains  three  gan- 
glia which  are  designated  as  superior,  middle  and  inferior, 
according  to  position.  These  ganglia  are  important  to  the 


PRINCIPLES  OF  OSTEOPATHY  131 

osteopath,  because  they  are  in  a  measure  affected  by  direct 
manipulation,  i.  e.,  pressure  can  be  transmitted  to  them 
through  the  soft  tissues  over  them. 

Superior  Cervical  Ganglion. — The  superior  cervical 
ganglion  lies  on  the  rectus  capitis  anticus  major  muscle  and 
sends  branches  upward  which  form  a  plexus  around  the  in- 
ternal carotid  artery  (carotid  plexus).  The  cavernous 
plexus  is  a  continuation  of  this.  From  these  plexuses  many 
communicating  branches  pass  to  unite  with  the  cranial 
nerves  of  the  cerebro-spinal  system. 

Connections. — This  ganglion  is  connected  with  the  first 
four  spinal  nerves  and  the  ninth,  tenth  and  twelfth  cranial. 
Its  branches  are  distributed  on  all  the  blood  vessels  of  the 
head  and  face. 

Vaso-CQnstriction. — Physiological  experiment  has  dem- 
onstrated that  this  ganglion  exercises  a  vaso-con stricter  in- 
fluence over  the  blood  vessels  of  the  head  and  face. 

Distribution. — "The  terminal  filaments  from  the  caro- 
tid and  cavernous  plexuses  are  prolonged  along  the  internal 
carotid  artery,  forming  plexuses  which  entwine  around  the 
cerebral  and  ophthalmic  arteries ;  along  the  former  vessels 
they  may  be  traced  into  the  pia  mater ;  along  the  latter,  into 
the  orbit,  where  they  accompany  each  of  the  subdivisions  of 
the  vessel,  a  separate  plexus  passing  with  the  arteria  cen- 
tralis  retinae,  into  the  interior  of  the  eye-ball.  The  fila- 
ments prolonged  on  to  the  anterior  communicating  artery 
form  a  small  ganglion,  'the  Ganglion  of  Ribes,  which  serves, 
as  mentioned  above,  to  connect  the  sympathetic  nerve  of  the 
right  and  left  side."  (Gray's  Anatomy,  page  871.) 

Reasoning  from  the  position  of  the  ganglion,  in  the 
neck,  its  distribution  to  blood  vessels  of  the  head  and  face, 
and  its  vaso-constrictor  functions  to  the  vessels,  we  can 
readily  understand  why  mechanical  lesions  in  the  upper 
cervical  region  can  be  the  cause  of  grave  pathological  condi- 
tions in  the  tissues  of  the  head  and  face.  Anything  which 


132  PRINCIPLES  OF  OSTEOPATHY 

disturbs  the  normal  circulation  in  a  definite  area  will  neces- 
sarily affect  the  nutrition  of  the  tissues  in  that  area;  there- 
fore, nutritional  disorders  of  the  eye  are  found  to  be  caused 
by  subluxation  of  vertebrae,  or  contraction  of  muscles  in  re- 
lation to  the  superior  cervical  ganglion. 

Headache. — Since  sympathetic  branches  are  distributed 
to  the  blood  vessels  of  the  pia  mater,  we  may  reasonably 
expect  to  affect  the  caliber  of  these  vessels  in  the  case  of 
congestive  headache,  by  removing  all  obstructions, — e.  g., 
contracted  muscles  causing  dilatation — to  the  active  func- 
tioning of  the  superior  cervical  ganglion.  The  distribution 
of  these  sympathetic  nerves  to  the  orbit,  nose,  pharynx, 
tonsils,  palate  and  sinuses,  explains  the  possibility — yes, 
probability — of  a  mechanical  lesion  in  the  upper  cervical 
region  in  these  cases. 

Middle  Cervical  Ganglion. — The  middle  cervical  gan- 
glion is  the  smallest  of  the  three.  "It  is  placed  opposite  the 
sixth  cervical  vertebra,  usually  upon  or  close  to  the  superior 
thyroid  artery;  hence  the  name  of  'Thyroid  Ganglion'  as- 
signed to  it  by  Haller."  It  sends  branches  to  the  fifth  and 
sixth  spinal  nerves. 

Distribution. — It  sends  branches  to  accompany  the  in- 
ferior thyroid  artery  to  the  thyroid  gland,  where  they  com- 
municate with  the  superior  and  recurrent  laryngeal  nerves. 
These  branches  regulate  the  caliber  of  the  inferior  thyroid 
artery  and  its  branches.  The  chief  nerve  trunk  passing  from 
this  ganglion  is  the  middle  cardiac  nerve.  The  cardiac  aug- 
mentors  leave  the  spinal  cord  as  white  rami-communicantes 
to  the  second,  third  and  fourth  dorsal  ganglia,  then  pass  up- 
ward to  the  middle  cervical  ganglicn.  This  ganglion  is 
connected  with  the  superior  cervical  ganglion. 

Function. — The  functions  of  this  ganglion  are  (a)  vaso- 
constrictor (through  connection  with  the  superior  cervical 
ganglion)  to  the  blood  vessels  of  the  head  and  face;  (b) 
vaso-constrictor  to  the  vessels  of  the  thyroid  gland;  (c) 
augmentor  influence  to  the  heart. 


PRINCIPLES  OF  OSTEOPATHY  133 

Manipulation. — Therefore,  inhibition  (pressure)  will 
lessen  those  influences,  and  stimulation  (make-and-break 
pressure)  will  increase  them.  Since  sympathetic  centers 
(ganglia)  control  vaso-motion  and  secretion,  we  may  con- 
sider that  this  ganglion  controls  vaso-motion  and  perspira- 
tion in  the  area  of  distribution  of  the  fifth  and  sixth  cervical 
spinal  nerves. 

Inferior  Cervical  Ganglion. — "The  inferior  cervical  gan- 
glion is  situated  between  the  base  of  the  transverse  process 
of  the  last  cervical  vertebra  and  the  neck  of  the  first  rib,  on 
the  inner  side  of  the  superior  intercostal  artery." 

Distribution. — It  connects  with  the  ganglion  above, 
and  the  fibers  which  connect  it  with  the  first  thoracic 
ganglion  pass  both  in  front  of  and  behind  the  subclavian 
artery.  Its  chief  branch  is  the  inferior  cardiac  nerve,  which 
communicates  with  the  middle  cardiac  nerve  and  the  recur- 
rent laryngeal  nerve.  It  sends  gray  rami-communicantes 
to  the  seventh  and  eighth  cervical  nerves ;  also  some 
branches  which  pass  upward  to  the  vertebral  artery.  The 
fibers  which  encircle  the  subclavian  artery  are  called  the 
Annulus  of  Vieussens,  and  some  fibers  to  the  cardiac  nerve 
are  given  off  from  it. 

Function. — From  this  distribution  we  may  draw  the  fol- 
lowing conclusions  as  to  the  function  of  the  inferior  cervical 
ganglion :  (a)  It  is  vaso-motor  to  the  area  of  distribution  of 
.the  seventh  and  eighth  cervical  nerves ;  (b)  it  controls  per- 
spiration in  this  same  area;  (c)  it  is  vaso-motor  to  the  ver- 
tebral artery  and  its  branches  in  the  posterior  fossa  of  the 
skull ;  (d)  vaso-motor  to  the  internal  mammary,  inferior  thy- 
roid, and  nervi  comes  phrenici  arteries;  (e)  augmentor  in- 
fluences to  the  heart. 

Manipulation. — Treatment  on  this  ganglion  would  les- 
sen its  vaso-constrictor  influence  over  the  arteries  named, 
and  they  would  then  carry  more  blood  at  a  slower  rate.  The 
stimulation  of  this  ganglion  would  raise  blood  pressure  in 
the  area  it  controls,  and  augment  the  force  of  the  heart. 


134  PRINCIPLES  OF  OSTEOPATHY 

Recapitulation. — It  has  been  mentioned  that  the  cervical 
iran u'lia  receive  no  white  rami-communicantes  from  the  cer- 

r*»          «•> 

vical  nerves,  and  that  vaso-constrictor  fibers  pass  from  cere- 
l)ro-s])inal  to  the  sympathetic  system  in  the  white  rami-com- 
municantes between  second  dorsal  and  second  lumbar  ver- 
tebrae; therefore,  the  constrictor  influence  manifested  by 
the  cervical  sympathetics  is  derived  from  the  second,  third 
and  fourth  dorsal.  They  derive  fibers  also  from  the  upper 
thoracic  region,  as  follows:  (a)  Augmentor  fibers  to  the 
heart  from  the  second,  third  and  fourth  dorsal;  (b)  secre- 
tory fibers  to  the  salivary  glands,  second  and  third  dorsal; 
(c)  pupilo-dilator  and  motor  fibers  to  the  involuntary  mus- 
cles of  the  eye  and  orbit  from  second  and  third  dorsal;  (d) 
afferent  fibers  whose  stimulation  causes  activity  of  the  vaso- 
motor  center  in  the  medulla. 

Thoracic  Ganglia. — "The  thoracic  portion  of  the  gan- 
gliated  cord  consists  of  a  series  of  ganglia  which  usually 
correspond  in  number  to  that  of  the  vertebrae,  but  from  the 
occasional  coalescence  of  two,  their  number  is  uncertain. 
These  ganglia  are  placed  on  each  side  of  the  spine,  resting 
against  the  head  of  the  rib  and  covered  by  the  pleura  cos- 
talis ;  the  last  two  are,  however,  anterior  to  the  rest,  being 
placed  on  the  sides  of  the  bodies  of  the  eleventh  and  twelfth 
dorsal  vertebrae.  The  ganglia  are  small  in  size,  and  of  a 
gray  color.  The  first,  larger  than  the  rest,  is  of  elongated 
form,  and  frequently  blended  with  the  last  cervical.  They 
are  connected  together  by  cord-like  prolongations  of  their 
substance.  In  the  thoracic  region  the  ganglia  are  connected 
with  the  spinal  nerves  by  both  white  and  gray  rami-com- 
municantes."— (Gray's  Anatomy,  page  804  in  1901  Edition.) 

Rami-efferentes. — The  rami-efferentes  or  branches  of 
distribution  are  divided  into  an  internal  and  external  set. 
The  external  branches  are  smaller,  being  distributed  to  the 
bodies  of  the  vertebrae  and  their  ligaments.  The  internal 
branches  may  properly  be  divided  into  an  upper  and  lower 
group,  which  are  distributed  to  the  viscera  of  the  thorax  and 
abdomen. 


PRINCIPLES  OF  OSTEOPATHY  135 

Upper  Five  Thoracic  Ganglia. — The  upper  five  thoracic 
ganglia  send  branches  which  are  distributed  around  the  up- 
per portion  of  the  descending  aorta.  From  the  second,  third 
and  fourth  ganglia  are  given  branches  to  the  posterior  pul- 
monary plexus,  which  control  the  tissues  of  the  lungs.  You 
will  remember  that  the  pneumogastric  nerves  are  the  motor, 
sensory  and  trophic  nerves  to  the  air  passages.  The  sympa- 
thetic, second  to  seventh  dorsal,  are  vaso-motor  and  trophic 
to  the  blood  vessels  of  the  tissues  of  the  lungs.  We  have 
now  laid  a  foundation  of  anatomical  and  physiological  facts 
upon  which  we  may  base  our  principles  of  treatment.  The 
upper  thoracic  region  is  an  important  one,  because  in  it  we 
find  not  only  those  white  rami-communicantes  which  are 
distributed  to  the  aorta  and  lungs,  joining  with  the  pneumo- 
gastric nerve  to  complete  the  plexuses  which  control  lung 
action,  but  also  those  white  rami-communicantes  which  as- 
cend to  the  cervical  ganglia,  and  are  distributed  as  follows : 

Nerve  Distribution. — "(1)  Pupilo-dilator  fibers  pass  by 
rami-communicantes  from  the  first,  second  and  third  tho- 
racic nerves,  ascend  in  the  sympathetic  cord  to  the  superior 
cervical  ganglion  to  form  arborizations  around  the  cells. 
These  gray  fibers  pass  to  the  Gasserian  Ganglion  and  reach 
the  eye  ball  by  the  ophthalmic  division  of  the  fifth  and  long 
ciliary  nerves ;  (2)  motor  fibers  to  the  involuntary  muscles 
of  the  orbit  and  eyelids,  from  the  fourth  and  fifth  thoracic 
nerves,  following  a  similar  course;  (3)  vaso-motor  fibers  to 
the  head,  secretory  fibers  to  the  submaxillary  glands,  and 
pilo-motor  fibers  to  the  head  and  neck,  are  derived  from  the 
upper  thoracic  nerve,  and  reach  their  area  of  distribution, 
after  similar  interruption,  in  the  superior  cervical  ganglion; 
(4)  the  accelerator  fibers  to  the  heart  are  derived  from  the 
upper  thoracic  nerves,  and  end  similarly  in  the  middle  and 
Unver  cervical  ganglia,  gray  fibers  in  the  cervical  cardiac 
nerve  completing  the  connection." — (Gerrish's  Anatomy, 
page  18.) 

Interscapular  Region. — Therefore,  we  have  an  area  ex- 
tending from  the  second  to  the  seventh  dorsal,  in  which  we 


136 


PRIXCIPLKS  OF  OSTEOPATHY 


must  make  careful  examination  for  lesions  affecting  vaso- 
motor,  trophic  and  secretory  activity  in  the  thoracic  vis- 
cera, upper  extremities,  and  structures  of  the  head,  face  and 
neck.  This  explains  to  you  why  a  treatment  in  the  inter- 
scapular  region  has  such  far-reaching  effects. 

A  Case  Illustrating  the  Cilio-spinal  Center. — As  an  il- 
lustration of  the  nerve  connection  between  the  cilio-spinal 
center,  first,  second  and  third  dorsal  and  the  eye,  I  wish  to 
call  your  attention  to  a  patient  now  in  the  clinic.  There 
was  extensive  inflammation  of  the  conjunctiva  of  the  right 
eye,  sight  in  that  eye  was  almost  gone  on  account  of  the 
opacity  caused  by  the  inflammation  of  the  conjunctiva  over 


Gojjerum 


p»o 

ccni-d 


Internol  curottd 
ortety 


FIG.  23.  Diagram  showing  cilio-spinal  center  and  the  course  of  the 
nerves  governing  accommodation  of  the  eye  to  light  and  distance. 
Drawn  by  John  Comstock  (after  Schuitz). 

the  cornea.  This  condition  was  present  for  five  years.  The 
inflammation  had  traveled  to  the  nasal  duct,  and  as  a  result 
it  was  closed.  The  duct  had  been  opened  by  the  surgeon's 
knife  long  before  we  saw  the  case.  A  close  examination  of 
the  center  likely  to  be  irritated  in  such  a  condition  disclosed 
the  fact  that  the  area  between  the  first  and  third  dorsal 
vertebrae  was  exceedingly  sensitive,  and,  most  interesting 
of  all,  pressure  on  this  area  caused  intense  pain  in  the  in- 
flamed eye,  and  caused  the  pupil  to  dilate.  The  muscles  in 


PRINCIPLES  OF  OSTEOPATHY  137 

the  interscapular  area  were  very  much  contracted.  Treat- 
ment was  given,  and  in  proportion  to  the  amount  of  relaxa- 
tion gained  in  the  interscapular  area,  the  inflammation  in 
the  conjunctiva  subsided.  After  one  month's  treatment,  the 
patient  could  see  to  thread  a  needle,  using  only  the  formerly 
diseased  eye.  Pressure  at  the  third  dorsal  spine  still  causes 
the  patient  to  speak  of  a  sense  of  pressure  or  swelling  in  the 
eye.  (Two  years  have  passed  since  this  was  written.  The 
patient  has  continued  to  have  perfect  use  of  the  eye.) 

The  following  extract  from  "The  Osteopath"  in  regard 
to  this  case  is  of  interest  to  us  while  considering  the  sympa- 
thetic nervous  system  :  "It  is  not  surprising  that  diseases  of 
the  eye  should  affect  the  sympathetic  nerve,  and  that  by  that 
path  the  center  known  as  the  'cilio-spinal.'  But  by  what 
sensory  path  would  the  influence  of  pressure  be  carried  to 
the  eye?  We  know  of  none.  From  the  first  two  dorsal 
nerves,  which  are  identical  with  the  cilio-spinal  center, 
sympathetic  fibers  are  distributed  to  the  dilating  muscle 
fibers  of  the  iris,  and  when  stimulated  cause  dilatation  of  the 
pupils.  From  the  third  dorsal  nerve  fibers  are  distributed 
which  regulate  the  caliber  of  the  blood  vessels  of  the  eye. 
Under  the  pressure,  either  set  of  these  fibers  may  be  af- 
fected. The  first  may  be  stimulated,  dilating  the  muscles  of 
the  iris  so  as  to  press  upon  filaments  of  sensitive  nerves ; 
or,  the  pressure  may  inhibit  the  vaso-constrictor  function  of 
the  other  nerve,  and  by  dilating  the  arterioles  cause  pressure 
upon  the  sensitive  nerve ;  or,  both  causes  may  operate  and 
thus  induce  the  pain.  The  abundant  supply  of  sensory 
nerves  to  the  ciliary  muscle,  iris  and  cornea,  from  the  nasal 
branch  of  the  ophthalmic  division  of  the  fifth  nerve  and  the 
short  ciliary  branches  from  the  ciliary  (lenticular  or  ophthal- 
mic) ganglion  makes  it  conceivable  that  any  change  of  ar- 
terial pressure  might  affect  these  nerves  to  the  extent  of 
causing  pain.  It  seems  reasonable  to  conclude  that  there 
was  no  inflammation,  but  congestion,  and  partial  paralysis 
of  the  vaso-constrictor  nerve." — (A.  E.  Brotherhood,  D.  O., 
D.  Sc.  O.,  in  "The  Osteopath,"  Vol.  V.,  No.  III.) 


138  PRINCIPLES  OF  OSTEOPATHY 

Effects  of  Treatment,  First  to  Seventh  Dorsal. — Treat- 
ment in  the  interscapular  region,  first  to  seventh  vertebrae, 
may  reasonably  be  expected  to  affect  the  heart  beat,  the  nu- 
tritional circulation  in  the  lungs,  and  the  circulation  in  the 
upper  extremities,  head,  neck  and  face. 

The  remainder  of  the  dorsal  area  constitutes  what  is 
called  the  splanchnic  region.  Three  splanchnic  nerves  are 
given  off  from  this  region  to  be  distributed  to  the  preverte- 
bral  plexuses  in  the  abdominal  cavity. 

The  Great  Splanchnics. — The  first  is  called  the  Great 
Splanchnic  and  takes  origin  from  the  sixth  to  the  tenth  dor- 
sal nerves,  and  probably  receives  many  filaments  from  the 
upper  dorsal  nerves.  It  is  a  large  nerve  trunk  and  contains 
many  medullated  nerves  from  the  cerebro-spinal  system. 
Its  course  is  downward  and  inward,  perforates  the  crus  of 
the  diaphragm  and  ends  in  the  semilunar  ganglion.  Some 
fibers  end  in  the  renal  and  suprarenal  plexuses. 

Lesser  Splanchnic. — The  Lesser  Splanchnic  arises  from 
the  tenth  and  eleventh  ganglia  and  their  connecting  cord. 
It  also  takes  a  downward  and  inward  course,  piercing  the 
•mis  of  the  diaphragm,  and  ends  in  the  Coeliac  Plexus.  It 
communicates  with  the  Great  Splanchnic,  and  sometimes 
sends  fibers  to  the  renal  plexus. 

Least  Splanchnic. — The  Least,  or  Renal  Splanchnic, 
arises  from  the  last  thoracic  ganglion  and  ends  in  the  renal 
plexus.  It  sometimes  communicates  with  the  lesser  splanch- 
nic. 

Functions. — First,  vaso-constriction  ;  second,  viscero- 
inhibition.  I  mention  merely  those  functions  which  have 
been  well  demonstrated  by  physiological  experiments  and 
osteopathic  practice. 

Theory. — The  osteopath  reasons  as  follows  concerning 
this  Splanchnic  area :  Since  the  Great  Splanchnic  ends  in 
the  semilunar  ganglion,  from  this  ganglion  and  plexuses 
around  it  fibers  are  distributed  to  the  blood  vessels  of  the 
stomach,  liver,  spleen  and  intestines ;  therefore,  we  operate 
in  the  area  between  the  fifth  and  tenth  dorsal  spines  for 


PRINCIPLES  OF  OSTEOPATHY  139 

vaso-motor  effects  on  the  above-mentioned  viscera.  Again, 
the  Great  Splanchnic  sends  viscero-inhibitory  fibers  to  the 
muscular  layers  of  the  stomach  and  intestines;  hence,  we 
control  excessive  muscular  activity  in  these  viscera  by  re- 
moving obstructions  to  the  normal  inhibitory  influence  of 
these  nerves.  The  Lesser  Splanchnic  has  the  same  func- 
tions, but  exercises  its  functions  chiefly  on  that  portion  of 
the  intestinal  muscular  layer  comprised  in  the  area  supplied 
by  the  superior  mesenteric  artery;  therefore,  the  tenth  and 
eleventh  dorsal  area  is  a  vaso-motor  and  motor-inhibitory 
center  for  a  segment  of  the  intestines.  The  renal  splanch- 
nics  exert  a  vaso-constrictor  influence  on  the  blood  vessels 
of  the  kidneys,  and  the  osteopath  secures  vaso-motor  effects 
on  the  blood  vessels  of  the  kidneys,  and  hence  effects  secre- 
tion by  removing  obstructions  to  the  normal  influence  of 
this  nerve. 

The  twelfth  dorsal  spine  marks  a  renal  center.  These 
nerves  contain  sensory  fibers  which  carry  sensation  from 
the  prevertebral  plexus  in  the  abdomen  to  the  spinal  cord. 
Therefore,  a  disturbance  in  the  viscera  can  reflex  its  painful 
sensations  to  the  area  of  greater  sensibility  which  is  in  close 
central  connection  with  the  seat  of  disturbance. 

It  should  be  borne  in  mind  that  the  power  of  movement 
resides  in  the  muscular  wall  of  the  intestine  and  is  initiated 
by  the  Automatic  Ganglia  in  its  walls,  which  are  excited  by 
the  pressure  of  food.  We  may  state  that  the  intestines  pos- 
sess an  intrinsic  nerve  apparatus  which  initiates  peristalsis, 
but  the  control  of  the  movement  after  it  is  initiated  is  exer- 
cised by  cerebro-spinal  nerves.  The  pneumogastric  nerve 
exercises  a  decided  motor  influence  over  the  intestines. 
As  previously  stated,  the  great  and  lesser  splanchnics  are 
inhibitory  nerves  to  the  musculature  of  the  intestines. 

Lumbar  Ganglia. — Four  small  ganglia,  connected  above 
and  below  by  intercommunicating  fibers,  constitute  the 
lumbar  portion  of  the  sympathetic  ganglia.  These  ganglia 
are  connected  with  the  cerebro-spinal  lumbar  nerves  by 
rami-communicantes.  The  first  and  second  ganglia  are  the 


140  PRINCIPLES  OF  OSTEOPATHY 

only  ones  in  this  region  receiving  white  rami-communi- 
cantes.  The  functions  which  we  found  were  exercised  in 
the  lower  dorsal  area  are  continued  into  the  lumbar  ganglia 
as  far  as  the  second.  These  ganglia  send  fibers  to  the  aortic 
plexus,  the  hypogastric  plexus,  and  thence  to  the  pelvic 
plexus.  They  also  send  branches,  as  in  other  regions,  to  the 
blood  vessels  supplying  the  bones  and  ligaments  of  the 
spinal  column. 

Since  vaso-constrictor  fibers  do  not  enter  the  sympa- 
thetic ganglia  below  the  second  lumbar,  we  may  reasonably 
expect  to  influence  the  circulation  of  the  lower  extremities 
by  manipulations  in  this  area. 

The  descending  colon  and  rectum  are  supplied  with  vis- 
cero-inhibitory  fibers  from  this  area.  Vaso-constrictor  fibers 
are  supplied  to  the  blood  vessels  in  the  lower  portion  of  the 
abdomen.  The  influence  exerted  by  the  lumbar  sympa- 
thetics  may  be  tabulated  as  follows : 

1st:  Viscero-inhibitory  to  descending  colon  and  rectum. 

2nd:  Vaso-constrictor  to  lower  abdominal  blood  vessels. 

3rd  :  Vaso-constrictor  to  the  blood  vessels  of  the  penis. 

4th :  Vaso-motor  fibers  to  the  blood  vessels  of  the  blad- 
der. 

5th :  Vaso-motor  fibers  to  the  blood  vessels  of  the 
uterus. 

6th  :  Vaso-constrictor  to  the  blood  vessels  of  the  pelvic 
viscera. 

7th:  Motor  to  vas  deferens  (male),  round  ligament 
(female). 

8th  :  Vaso-constrictor  to  the  blood  vessels  of  the  lower 
extremities. 

Sacral  Ganglia. — The  pelvic  portion  of  the  sympathetic 
chain  usually  consists  of  four  ganglia  situated  along  the 
inner  side  of  the  sacral  foramina,  and  communicates  with 
the  four  upper  sacral  nerves.  These  ganglia  are  connected 
with  each  other,  as  in  other  regions.  The  two  chains  con- 
nect by  the  Ganglion  Impar  on  the  anterior  surface  of  the 
coccyx. 


PRINCIPLES  OF  OSTEOPATHY  141 

Distribution. — The  rami-efferentes  are  distributed  to 
the  pelvic  plexus;  or  a  plexus  on  the  middle  sacral  artery, 
and  to  vertebrae  and  ligaments  in  the  sacral  region. 

"Through  the  pelvic  plexus,  the  pelvic  viscera  are  sup- 
plied with  motor,  vaso-motor  and  secretory  fibers."  (Ger- 
rish's  Anatomy,  page  648.) 

The  rami-communicantes  in  the  sacral  region  are  gray, 
hence,  the  influence  of  the  cerebro-spinal  system  is  carried 
down  from  the  upper  lumbar  ganglia. 

"Below  the  second  lumbar  vertebra  they  are  also  of  the 
gray  peripheral  variety."  ("Abdominal  Brain,"  page  31.) 

In  the  sacral  region  the  spinal  nerves  are  distributed 
directly  to  the  pelvic  viscera;  some  fibers  pass  into  the 
pelvic  plexus,  thence  to  the  viscera. 

The  sacral  region  offers  an  area  in  which  the  osteo- 
path can  secure  an  influence  on  pelvic  viscera  without  the 
extensive  sympathetic  connections  encountered  in  other 
regions  of  the  spine. 

Function. — These  sacral  nerves  are  : 

1st :  Vaso-dilator  to  the  vessels  of  the  penis  and  vulva. 

2nd :  Motor  fibers  to  the  rectum. 

3rd  :  Motor  fibers  to  the  bladder. 

4th :  Motor  fibers  to  the  uterus. 

Cardiac  Plexus. — The  three  great  prevertebral  plex- 
uses must  now  engage  our  attention.  The  first  one,  the  car- 
diac plexus,  is  situated  at  the  base  of  the  heart,  and  in  the 
concavity  of  the  arch  of  the  aorta;  this  portion  is  called  su- 
perficial, while  the  deep  portion  lies  between  the  trachea  and 
the  aorta. 

Position  and  Formation. — The  cardiac  plexus  is  formed 
by  fibers  from  the  pneumogastric  and  cervical  cardiac  sym- 
pathetics.  "It  is  very  common  to  find  upper  cervical  cardiac 
branches  of  the  vagus  and  sympathetic  united  to  form  a 
common  trunk.  In  other  cases,  the  nerves  branch  and  com- 
municate with  each  other  in  a  plexiform  manner."  (Mor- 
ris's Anatomy.) 


142  PRINCIPLES  OF  OSTEOPATHY 

The  cardiac  nerves  form  the  cervical  sympathetic  chain; 
all  enter  the  cardiac  plexus,  but  their  distribution  is  varia- 
ble. The  superficial  plexus  receives  the  "left  superior  car- 
diac nerve  of  the  sympathetic  and  the  left  inferior  cervical 
cardiac  branch  of  the  pneumogastric." — (Morris's  Anat- 
omy.) 

The  deep  cardiac  plexus  "receives  all  the  other  cardiac 
nerves."  From  the  superficial  cardiac  plexus  branches  pass 
to  the  plexus  around  the  right  coronary  artery  and  pass  to 
the  left  lung  to  join  the  anterior  pulmonary  plexus. 

From  the  deep  cardiac  plexus  branches  are  distributed 
to  the  anterior  pulmonary  plexus  of  both  sides,  the  left  coro- 
nary plexus,  right  auricle,  superficial  cardiac  plexus,  and 
right  coronary  plexus. 

Pulmonary  Plexus. — The  anterior  pulmonary  plexus  is 
formed  by  a  branch  of  the  pneumogastric  and  the  sympa- 
thetic. It  is  situated  on  the  anterior  surface  of  the  bronchi 
and  the  branches  enter  the  lung  on  the  bronchus. 

The  posterior  pulmonary  plexus  is  formed  by  the  pneu- 
mogastric and  fibers  from  the  second,  third  and  fourth  tho- 
racic ganglia  of  the  sympathetic.  Its  branches  enter  the 
lung  on  the  posterior  aspect  of  the  bronchus. 

Physiology. —  Physiological  experiments  have  demon- 
strated that  the  pneumogastric  is  motor  to  the  muscles  of 
the  bronchioles,  sensory  and  trophic,  while  the  sympathetics 
are  vaso-motor  and  trophic.  Therefore,  the  function  of  the 
lungs  and  heart  can  be  affected  by  operating  on  the  inter- 
scapular  region. 

Functions. — The  functions  of  the  thoracic  plexus  are: 

1st:  Cardiac  augmentors.  per  sympathetics. 

2nd  :  Cardiac  inhibitor,  per  pneumogastric. 

3rd :  Vaso-constrictor  to  coronary  arteries,  per  pneumo- 
gastric. 

4th :  Vaso-constrictor  to  bronchial  arteries,  per  sympa- 
thetic, first  to  fifth  dorsal. 


PRINCIPLES  OF  OSTEOPATHY  143 

5th :  Sensory  fibers  to  the  pleura  and  lungs,  per  sympa- 
thetic, first  to  fifth  dorsal. 

6th :  Sensory  fibers  to  heart  and  pericardium,  per  sym- 
pathetic, second  to  fifth  dorsal. 

7th  :  Broncho-constrictor,  per  pneumogastric. 

8th  :  Broncho-dilator,  per  pneumogastric. 

9th :  Sensory  fibers  to  mucous  lining  of  air  passages, 
per  pneumogastric. 

Treatment^ — A  true  inhibitory  treatment  would  pro- 
duce greatest  effect  on  the  heart,  if  administered  over  the 
middle  and  inferior  cervical  ganglia.  The  heart  would  be 
slowed.  Such  a  treatment  is  rarely  given,  because  nearly 
every  case  presents  some  physical  lesion  which,  if  removed, 
allows  normal  impulses  to  meet  in  the  cardiac  plexus  and 
be  re-organized  for  proper  distribution. 

Always  bear  in  mind  that  a  plexus  is  a  re-organizing 
center  for  nervous  impulses,  and  we  can  hope  only  to  regu- 
late the  function  of  an  organ  by  attempting  to  equalize  the 
impulses  reaching  its  controlling  plexus.  This  equalizing 
process  is  not  ordinarily  secured  by  the  administration  of 
inhibition  to  a  definite  nerve  trunk  which  ends  in  the  plexus, 
but  by  removing  a  lesion, — usually  bony  or  muscular — 
which  is  affecting  the  nerve  fiber  in  the  direction  of  increase 
or  decrease  of  function. 

The  region  between  the  scapulae  is  in  close  central 
connection  with  the  lungs,  pleura,  heart  and  pericardium; 
hence,  painful  sensations  originating  in  these  organs  may  be 
referred  to  this  area.  The  muscles  in  this  area  will  contract 
reflexly  from  irritation  of  these  organs,  or  from  exposure  of 
the  skin  over  them  to  a  change  of  temperature.  Hence,  in 
the  first  instance  the  contraction  is  a  secondary  lesion;  in 
the  latter,  a  primary  one. 

Pressure  in  this  area  practically  causes  relaxation  of 
muscles,  removes  a  lesion;  but  the  patient  experiences  a 
cessation  of  pain,  freer  respiration,  and  less  rapid  action  of 
the  heart. 


144  PRINCIPLES  OF  OSTEOPATHY 

Results. — After  administering  inhibitory  pressure,  the 
osteopath  realizes  that  the  muscles  under  his  fingers  are 
softer  than  formerly;  then  he  knows  that  he  has  actually 
changed  the  physiological  condition  of  an  important  tissue. 

Argument. — Coincident  with  the  softening  of  the  mus- 
cles, the  heart  beats  slower;  therefore,  he  has  removed  an 
irritant  to  the  augmentor  fibers  of  the  heart;  the  respiration 
is  deeper,  therefore  a  change  has  been  secured  in  the  ac- 
tivity of  the  walls  of  the  thorax,  and  in  the  circulation  of 
blood  in  the  bronchial  and  pulmonary  blood  vessels;  the 
pain  has  decreased,  therefore  the  sensory  nerves  in  the  lung 
tissue  are  no  longer  irritated  by  hyperaemic  pressure  or 
toxic  substances  in  the  blood.  This  illustrates  to  you  why 
the  osteopath  studies  and  treats  the  interscapular  region  so 
carefully. 

Solar  Plexus. — In  the  abdominal  cavity  we  find  the  so- 
lar plexus,  which  on  account  of  its  great  size  and  wonderful 
distribution,  Ryron  Robinson  calls  the  "Abdominal  Brain." 

Location  and  Formation. — It  is  placed  in  front  of  the 
aorta  at  its  entrance  into  the  abdomen,  and  surrounds  the 
Coeliac  Axis.  It  consists  of  two  semilunar  ganglia,  which 
are  placed  on  each  side  of  the  coeliac  axis,  and  are  connected 
by  a  large  number  of  fibers  which  pass  above  and  below  the 
coeliac  axis.  From  this  circle  of  ganglia  and  nerves,  fibers 
are  given  off  which  are  joined  by  branches  of  the  right  pneu- 
mogastric,  and  by  both  small  splanchnics.  The  great 
splanchnic  ends  in  the  semilunar  ganglion. 

Distribution. — The  branches  of  distribution  from  the 
solar  plexus  are  prolonged  on  the  branches  of  the  abdominal 
aorta  as  subsidiary  plexuses,  taking  their  names  from  the 
arteries  they  accompany,  as  splenic,  gastric,  hepatic,  dia- 
phragmatic, suprarenal  and  renal,  superior  mesenteric,  in- 
ferior mesenteric,  aortic  and  spermatic.  The  ultimate  dis- 
tribution of  the  branches  of  the  solar  plexus  is  to  the  mus- 
cular and  secretory  tissues  of  all  the  abdominal  viscera,  and 


PRINCIPLES  OF  OSTEOPATHY  145 

to  the  muscular  coat  of  the  arteries  supplying  these  viscera. 
This  great  plexus  is  the  vaso-motor  center  for  the  ab- 
dominal viscera.  "It  is  connected  with  almost  every  organ 
in  the  body,  with  a  supremacy  over  visceral  circulation, 
with  a  control  over  visceral  secretion  and  nutrition,  with  a 
reflex  influence  over  the  heart  that  often  leads  to  fainting, 
and  may  even  lead  to  fatality." — "Abdominal  Brain,"  page 
76. 

Function. — We  find  that  the  great  and  the  small 
splanchnics  and  right  pneumogastric  are  the  chief  contribu- 
tors to  the  solar  plexus,  and  in  order  to  get  a  clear  idea  of 
the  functions  of  this  plexus,  we  may  tabulate  them  as  fol- 
lows : 

1st:  Viscero-motor  to  stomach,  small  intestines,  as  far 
as  sigmoid  flexure,  per  pneumogastric. 

2nd :  Sensory  to  stomach  and  small  intestines,  per 
pneumogastric. 

"If  the  pneumogastric  nerve  be  divided  during  full  di- 
gestion in  a  living  animal,  in  which  a  gastric  fistula  has 
been  established,  so  that  the  interior  of  the  stomach  can  be 
examined,  the  muscular  contractions  will  be  observed  to 
cease  instantly;  the  mucous  membrane  to  become  pale  and 
flaccid;  the  secretion  of  the  gastric  juice  to  be  arrested,  and 
the  organ  to  have  become  insensible.  There  can  be  no 
doubt,  also,  that  stimulation  of  the  pneumogastric  nerves 
causes  the  stomach  to  contract,  and  that  digestion  may,  to  a 
certain  extent,  at  least,  be  re-established  by  stimulation  of 
the  peripheral  extremities  of  the  divided  nerves." — (Chap- 
man's Phys.,  page  680.) 

3rd :  Viscero-inhibitory,  per  splanchnics. 

4th :  Vaso-motor,  per  splanchnics. 

5th :  Sensory,  per  splanchnics. 

6th  :  Sensory,  per  pneumogastric  and  splanchnics. 

The  fibers  of  the  great  and  small  splanchnics  come 
from  the  sympathetic  ganglia  in  the  dorsal  region,  sixth  to 
eleventh. 


146  PRINCIPLES  OF  OSTEOPATHY 

These  ganglia  may  receive  fibers  from  some  of  the  up- 
per dorsal. 

Centers. — The  facts  just  stated  give  us  a  foundation 
for  osteopathic  treatment  to  influence  motion,  sensation,  se- 
cretion, and  vaso-motion  in  the  abdominal  viscera.  The 
area  in  the  vertebral  column  which- we  may  consider  as  con- 
taining centers  for  these  various  functions  lies  between  the 
sixth  and  eleventh  dorsal  spines.  The  fibers  from  this  region 
have  a  segmental  distribution  to  the  abdominal  viscera; 
therefore,  the  stomach,  liver,  gall  bladder,  spleen  and  in- 
testines each  have  a  limited  portion  of  this  area  which  is 
their  special  center;  at  least,  painful  sensations  are  reflexed 
from  them  to  a  definite  point  in  the  vertebral  column  be- 
tween the  sixth  and  eleventh  dorsal  spines.  The  enormous 
regulative  influence  which  can  be  excited  by  an  osteopathic 
treatment  in  this  area  is  being  demonstrated  daily. 

We  have  already  mentioned  the  fact  that  the  intestines 
will  contract  after  being  separated  from  the  body,  thereby 
proving  that  the  intrinsic  power  to  cause  movement  lies  in 
the  nervous  mechanism  in  the  gut  walls.  Keep  constantly 
in  mind  the  regulative  character  of  the  impulses  which 
enter  the  "abdominal  brain"  over  the  pneumogastric  and 
splanchnic  nerves. 

The  vaso-motor  phenomena  in  this  area  have  been  dis- 
cussed in  another  chapter. 

Hypogastric  Plexus — Location  and  Formation.  —  The 
great  re-organizing  center  for  the  pelvic  viscera  is  called 
the  hypogastric  plexus,  which  lies  anterior  to  the  fifth  lum- 
bar vertebra.  It  is  formed  by  a  continuation  of  fibers  from 
the  aortic  plexus  which  are  joined  by  fibers  from  the  lum- 
bar sympathetic  ganglia.  In  front  of  the  sacrum  the  plexus 
divides  into  two  portions,  which  join  the  pelvic  plexuses 
lying  on  each  side  of  the  rectum  and  bladder,  in  the  male, 
and  of  the  rectum,  vagina  and  bladder  in  the  female. 

Pelvic  Plexus. — These  pelvic  plexuses  contain  many 
small  ganglia,  and  are  joined  by  fibers  from  the  upper  sacral 


PRINCIPLES  OF  OSTEOPATHY  147 

sympathetic  ganglia,  and  by  direct  branches  of  the  second, 
third  and  fourth  sacral  cerebro-spinal  nerves. 

Distribution. — The  branches  of  these  plexuses  are  dis- 
tributed on  the  coats  of  the  arteries  to  the  pelvic  viscera, 
and  frequently  enter  the  substance  of  the  organ. 

Subsidiary  Plexuses. — According  to  the  artery  fol- 
lowed, we  have  subsidiary  plexuses,  called  hemorrhoidal, 
visceral,  prostatic,  vaginal  and  uterine. 

Functions. — The  functions  of  the  pelvic  plexus  are  as 
follows : 

(1)  Vaso-constrictor,  (2)  vaso-motor,  (3)  sensory,  (4) 
viscero-inhibitor,  per  hypogastric  plexus. 

(5)  Motor  to  rectum,  vagina  and  bladder,  (6)  sensory 
to  rectum,  vagina  and  bladder,  (7)  vaso-dilator  to  sexual 
organs,  erectile  tissue,  (8)  viscero-constrictor  to  neck  of 
uterus,  per  second,  third  and  fourth  sacral. 

Summary. — With  the  arrangement  and  functions  of 
these  nerves  well  in  mind,  we  recognize  two  paths  over 
which  we  can  influence  the  pelvic  viscera : 

(1)  Sensory  influences   may  be   reflexed   through   the 
hypogastric  plexus,  and  thence  to  the  second  lumbar;  or, 
they  may  pass  over  sacral  nerves  to  the  same  point,  second 
lumbar.     In  connection  with  disturbance  of  the  pelvic  vis- 
cera, pain  may  be  reflexed  on  to  the  back  of  the  sacrum, 
or  to  an  area  around  the  second  lumbar.     Disturbance  of 
function  in  the  uterus  causes  reflex  sensitiveness  at  fourth 
and  fifth  lumbar. 

(2)  Vaso-constrictor   influences-  come    through   hypo- 
gastric  plexus  from  spinal  nerves  about  second  lumbar. 

(3)  Vaso-dilator  influences  come  directly  to  the  pelvic 
plexuses     from     second     and    third     sacral     nerves;    nervi 
erigentes. 

(4)  Viscero-motor  influences  chiefly  from  second,  third 
and  fourth  sacral. 

(5)  Viscero-inhibitory  influences,  chiefly  through  hypo- 
gastric  plexus,  probably  from  upper  lumbar  spinal  nerves. 


148  PRINCIPLES  OF  OSTEOPATHY 

We  have  therefore  a  vaso-constrictor  center  for  pelvic 
viscera  at  second  lumbar;  a  vaso-dilator  and  motor  center 
at  second  and  third  sacral. 

Automatic  Visceral  Ganglia. — The  last  portion  of  the 
sympathetic  is  but  little  known,  and  physiologists  Iftve 
refrained  from  speculating  on  it  until  more  definite  knowl- 
edge is  obtained. 

Byron  Robinson  mentions  a  number  of  "automatic 
visceral  ganglia"  situated  in  the  walls  of  the  hollow  viscera. 
The  fact  that  the  heart,  intestines,  uterus,  bladder  and 
fallopian  tubes  will  contract  rhythmically  in  response  to 
mechanical  stimulation  after  all  nerve  connections  are 
severed,  seems  to  prove  the  existence  of  ganglia  in  the  walls 
of  these  viscera  which  are  capable  of  receiving  sensation 
and  sending  out  motor  impulses. 

Conclusions. — We  will  therefore  conclude  that  the 
sympathetic  system  can  act  independently  of  the  cerebro- 
spinal ;  that  it  receives  sensation,  and  initiates  motion; 
gives  tone  to  the  arteries,  and  controls  secretion.  We  in- 
fluence the  functions  of  the  sympathetic  through  its  con- 
nection with  the  cerebro-spinal  system. 


PRINCIPLES  OF  OSTEOPATHY  149 


CHAPTER  IX. 

CIRCULATORY  TISSUE. 

From  the  histological  standpoint,  blood  conforms  to 
the  general  definition  of  a  tissue,  being  composed  of  a 
cellular  and  intercellular  substance.  The  intercellular  sub- 
stance, being  liquid,  differentiates  it  greatly  from  other 
tissues.  It  contains  cellular  elements  which  differ  from 
each  other  in  form  and  function.  Then,  too,  it  is  a  moving 
tissue  enclosed  in  a  system  of  closed  tubes. 

Functions. — The  blood  performs  many  functions. 
These  may  be  stated  in  general  terms  as  follows : 

1.  To  convey  nutrition  to  all  other  tissues. 

2.  To  remove  waste  products  from  the  tissues. 

3.  To  convey  oxygen  for  tissue  respiration. 

4.  To  distribute  heat. 

5.  To  repel  invasion  of  bacteria. 

Lymph. — Lymph  is  another  liquid  tissue,  less  rich  in 
corpuscular  elements,  but  greater  in  total  bulk  than  the 
blood.  The  lymph  comes  in  direct  contact  with  the  ele- 
ments of  the  tissues.  Stewart  states  the  relationship 
tersely  when  he  says,  "The  blood  feeds  the  lymph  and  the 
lymph  feeds  the  cell." 

Since  we  think  of  individual  tissues  as  possessing  some 
one  well  developed  attribute  or  function,  it  is  well  to  call 
blood  and  its  congener,  lymph,  the  media  of  exchange. 
This  expression  covers  at  least  four  of  the  functions  pre- 
viously mentioned. 

With  this  comprehensive  but  short  statement  of  the 
relation  of  these  liquid  tissues  to  the  structural,  contractile, 
irritable  and  secretory  tissues,  it  seems  hardly  necessary 


150  PRINCIPLES  OF  OSTEOPATHY 

to  discuss  so  self-evident  a  proposition  as  that  health  pri- 
marily depends  on  a  perfect  circulation.  It  is  not  even 
necessary  to  add  to  this  the  fact  that  the  blood  should  be 
pure,  because  under  ordinary  circumstances  if  the  blood 
circulates  properly  it  will  become  purified. 

All  schools  of  medicine  have  a  therapeutic  principle 
around  which  their  practice  is  built.  From  its  earliest  in- 
ception the  osteopathic  idea  has  been  that  a  perfect  circu- 
lation is  the  foundation  for  perfect  health. 

The  proportion  of  blood  to  body  weight  is  about  one- 
twelfth  of  the  whde.  i.  e.,  twelve  pounds  of  blood  in  a 
body  weighing  150  pounds.  This  amount  of  blood  is  dis- 
tributed approximately  as  follows:  One-fourth  to  the 
heart,  lungs  and  »Teat  blood  vessels;  one-fourth  to  the  liver; 
one-fourth  to  the  resting  muscles;  one-fourth  to  the  re- 
maining organs.  There  is  not  blood  enough  in  the  body 
to  maintain  all  of  its  activities  at  the  maximum  at  the 
same  time.  Therefore  it  is  difficult  to  do  the  best  physical 
or  mental  labor  just  after  digestion  has  begun.  The 
splanchnic  blood  vessels  are  capable  of  containing  so  large 
a  proportion  of  the  whole  amount  of  blood  that  death  may 
result  from  lack  of  sufficient  blood  returning  to  the  heart 
to  cause  it  to  beat. 

Distribution  of  the  Blood. — Granting  that  the  blood 
possesses  all  these  functions,  the  question  still  confronts 
us,  how  can  we  affect  its  distribution?  This  question  leads 
us  to  a  consideration  of  the  physiological  distribution  of 
the  blood.  It  is  believed  by  the  writer  that  nothing  be- 
sides the  use  of  water  has  so  great  an  effect  on  the  circu- 
lation of  the  blood  as  manipulation  according  to  osteopathic 
methods.  These  methods  do  not  depend  on  a  mere  physi- 
cal assistance  of  the  venous  flow  by  means  of  centripetal 
stroking,  such  as  is  employed  by  a  masseur.  Effects  on 
circulation  are  obtained  in  nearly  all  cases  by  knowing 
where  definite  nerves  which  control  the  action  of  the  heart 
and  blood  vessels  are  placed  and  what  their  action  in  re- 
sponse to  irritation  may  be.  All  manipulations  are  given 


PRINCIPLES  OF  OSTEOPATHY  151 

with  a  definite  knowledge  of  the  location  of  blood  vessels 
and  the  nerve  centers  which  control  their  variation  in 
caliber.  The  response  secured  is  a  new  coordination  of 
the  whole  circulation  brought  about  under  the  control  of 
the  nerve  centers. 

It  has  been  stated  that  the  blood  is  contained  in  a 
closed  system  of  tubes.  A  short  resume  of  the  most  im- 
portant points  in  the  anatomy  and  physiology  of  the  cir- 
culation may  prepare  us  for  a  clearer  insight  of  the  modus 
operandi  of  osteopathic  methods. 

The  Circulatory  Apparatus. — The  circulatory  appa- 
ratus consists  of  the  heart,  arteries,  capillaries,  veins  and 
lymphatics ;  some  writers  include  the  spleen. 

Muscular  tissue  is  found  in  the  heart,  small  arteries 
and  veins.  The  heart  is  practically  all  muscle,  and  its  con- 
tractions are  governed  by  two  sets  of  nerve  fibers  from  the 
cerebro-spinal  system;  the  first  set  is  called  accelerator; 
second,  inhibitory. 

Likewise,  the  small  arteries  and  veins  have  two  sets 
of  fibers  which  increase  and  decrease  the  intensity  of  the 
contraction  of  their  muscular  fibers,  and  thus  change  the 
caliber  of  the  vessels. 

The  capillaries  are  short,  narrow  tubes,  having  a  thin 
wall  composed  of  nucleated  cells  which  possess  the  power 
of  contraction.  So  far  as  known,  the  capillaries  expand 
and  contract  in  response  to  the  degree  of  physical  pressure 
exerted  by  the  blood  current  coming  from  the  arterioles. 
Thus  the  change  in  the  caliber  of  the  capillaries  is  pas- 
sive. The  lymphatics  begin  in  small  irregular  spaces  in 
the  cellular  tissue  outside  of  the  blood  vessels.  They  are 
found  in  direct  relation  with  the  cells  of  perivascular  tis- 
sues, thus  bringing  the  lymph  to  each  cell.  These  open- 
ings lead  to  small  lymphatic  vessels  which  convey  the 
lymph  to  the  lymphatic  glands  which  are  situated  so  as 
to  filter  out  the  impurities,  after  which  it  is  emptied  into 
the  venous  circulation  by  the  lymphatic  ducts.  The  lym- 


152  PRINCIPLES  OF  OSTEOPATHY 

phatic  vessels  possess  power  of  contraction.  The  lymph 
equals  about  one-third  of  the  body  weight. 

The  blood  is  a  passively  moving  tissue.  It  is  kept  in 
constant  circulation  within  a  closed  system  of  tubes  by  a 
combination  of  forces.  The  propulsion  of  the  blood  is  al- 
most entirely  accomplished  by  the  contraction  of  the  heart. 
This  initial  force  is  supplemented  by  the  aspiration  of  the 
chest  during  respiration,  and  the  contraction  of  the  skele- 
tal muscles  of  the  entire  body.  It  is  a  debatable  question 
whether  or  not  the  muscular  coat  of  the  arterioles  and 
venules  assist  in  the  direct  propulsion  of  the  blood  passing 
through  them. 

It  is  the  function  of  the  heart  to  maintain  a  compara- 
tively uniform  tension  of  the  blood  in  the  large  arteries. 
The  arterioles  and  capillaries  are  concerned  in  maintain- 
ing resistance  to  the  passage  of  the  blood.  The  degree  of 
resistance  in  the  capillaries,  in  large  measure,  determines 
the  amount  of  nourishment  received  by  the  tissues.  The 
relation  between  capillary  resistance  to  the  passage  of 
the  blood  and  the  metabolism  carried  on  in  perivascular 
tissues  is  a  point  of  great  importance.  The  current  of 
blood  ordinarily  passes  through  the  capillaries  very  slowly, 
at  a  rate  of  one  inch  in  two  minutes,  and  under  low  ten- 
sion, thus  giving  ample  opportunity  for  the  escape  of  nour- 
ishing material  for  the  surrounding  tissues. 

Tension  in  the  arteries  is  maintained  by  three  factors : 
(1)  The  initial  force  of  the  heart  beat;  (2)  friction  in  the 
vessels;  (3)  elasticity  of  the  vessel  walls.  The  first  and 
third  of  these  factors  are  under  nerve  control  which  act 
according  to  a  large  number  of  stimuli. 

The  capillaries  being  passive  in  action,  the  tension  of 
the  blood  stream  in  them  is  mainly  dependent  on  the  ten- 
sion in  the  arterioles.  It  may  be  profitably  noted  that 
after  the  initial  impulse  is  given  to  the  blood  stream  by 
the  heart,  the  distribution  of  this  blood  depends  solely  on 
the  arteries,  arterioles  and  capillaries.  This  peripheral 
distributive  mechanism  is  therefore  responsible  for  the 


153 

nutrition  of  the  tissues,  and  its  resistance  offered  to  the 
passage  of  the  blood  regulates  the  amount  of  force  ex- 
erted by  the  heart. 

Manipulatory  treatments,  according  to  the  best  authori- 
ties writing  on  massage  and  Swedish  movements,  have 
for  their  object  the  acceleration  of  the  blood  flow  on  the 
venous  side  of  the  general  circulation.  Osteopathic  man- 
ipulations are  essentially  directed  to  the  active  instead  of 
the  passive  side  of  the  circulation. 

The  osteopath  makes  use  daily  of  the  vaso-motor 
nerves  in  order  to  control  the  circulation  of  the  blood  in 
local  areas;  therefore,  it  is  necessary  to  make  a  detailed 
study  of  this  wonderful  mechanism  in  order  to  achieve 
the  best  results  in  practice. 

The  more  we  know  of  structure  and  function,  the  more 
rational  ought  our  methods  of  treatment  to  be,  because 
we  will  then  have  no  excuse  for  using  methods  which  do 
not  have  a  scientific  basis  to  recommend  them. 

The  Heart. — In  order  to  affect  the  active  side  of  the 
circulation  our  manipulations  must  affect  the  heart  beat. 
There  are  two  sets  of  nerve  fibers  arising  in  the  cerebro- 
spinal  system  which  exert  a  regulating  influence  on  the 
beat  of  the  heart.  Heart  muscle  possesses  an  inherent 
power  of  rhythmical  contraction.  It  will  beat  rhythmical- 
ly for  hours  if  the  muscle  be  kept  moist  with  a  one  per 
cent  salt  solution. 

Contraction  begins  in  the  auricles  and  ends  in  the  ven- 
tricles; hence,  it  is  thought  that  the  auricular  rhythm  is 
transmitted  to  the  ventricle.  Any  influence  which  changes 
the  auricular  rhythm  also  changes  the  ventricular  rhythm. 

Regulation  of  Contraction. — Since  the  heart  possesses 
inherent  power  of  rhythmic  contraction,  the  nervous  sys- 
tem acts  as  a  regulator  of  the  rate  of  contraction.  The 
two  centers  of  cardiac  control  act  in  a  manner  to  increase 
or  decrease  the  rate.  The  speed  of  the  blood  current  is 
dependent  on  the  rate  and  strength  of  the  cardiac  con- 
tractions. The  pressure  of  the  blood  is  dependent  on  the 


154  PRINCIPLES  OF  OSTEOPATHY 

rate  and  strength  of  the  cardiac  contractions,  together 
with  the  resistance  offered  by  the  arterioles  and  capillaries. 
Considering  the  arterioles  and  capillaries  as  possessing 
fixed  diameters,  an  increase  in  the  number  and  strength 
of  the  heart  beats  would  increase  the  speed  and  pressure 
of  the  blood  current.  A  lessened  cardiac  activity  would 
have  the  opposite  effect.  The  speed  and  pressure  of  the 
blood  stream  may  vary  within  wide  limits  and  still  main- 
tain a  fair  degree  of  health. 

Coordinating  Centers. — The  nerve  impulses  reaching 
the  heart  are  coordinated  in  two  governing  centers  in  the 
cerebro-spinal  system.  These  centers  are  located  in  the 
bulb.  The  inhibitory  center  is  connected  with  cells  in  the 
walls  of  the  heart  by  fibers  which  form  a  part  of  the  pneu- 
mogastric  nerve.  Section  of  the  pneumogastric  nerve  re- 
moves the  inhibitory  influence  over  the  heart's  action. 
Stimulation  of  this  nerve  slows  the  heart.  The  relaxation 
period  is  lengthened  which  results  in  greater  filling  of  the 
heart  and  the  pressure  in  the  veins  is  increased  while  ar- 
terial pressure  decreases.  These  results  have  been  noted 
by  many  physiologists. 

The  Pneumogastric  Nerve. — The  pneumogastric  is  one 
of  the  nerve  trunks  which  can  be  reached  by  direct  pres- 
sure made  through  the  skin  and  muscles  of  the  neck.  Its 
inhibitory  action  can  be  aroused  by  pinching  the  sterno- 
cleidomastoid  muscle  between  the  thumb  and  forefinger, 
taking  care  to  work  deeply  under  the  internal  margin  of 
the  muscle. 

It  is  no  uncommon  phenomenon  to  have  a  patient 
faint  as  a  result  of  this  manipulation.  Individuals  differ 
greatly  as  to  their  response  to  this  stimulation.  The  stim- 
ulation should  be  a  gentle  pressure  of  a  constantly  vary- 
ing intensity. 

A  pulse  tracing  is  appended,  Fig.  24,  which  shows  the 
results  of  stimulating  the  pneumogastric  in  the  manner 
just  described.  The  gentleman  upon  whom  the  experi- 


PRINCIPLES  OF  OSTEOPATHY 


155 


ment  was  made  was  in  excellent  health,  and  possessed  a 
quiet,  well-balanced  temperament.  The  tracing  shows 
that  the  number  and  force  of  the  beats  was  lessened  and 
the  arterial  pressure  decreased.  This  tracing  is  probably 


'  /  ' 


/  /  yy  / 


FIG.   24.     Stimulation  of  the  pneumogastric  by  pinching  the  nerve  trunk 
in   the  neck. 

typical  of  the  change,  in  a  well  person,  in  response  to  stim- 
ulation of  the  pneumogastric.  No  sensation  of  faintness 
or  other  disagreeable  feeling  was  noted. 

The  inhibitory  action  of  the  pneumogastric  seems 
to  be  most  active  in  individuals  who  suffer  from  some  dis- 
order of  the  digestive  tract.  In  such  patients  the  constant 
irritation  of  the  sensory  fibers  of  the  pneumogastric,  which 
arise  in  the  mucosa  of  the  digestive  viscera,  seems  to  in- 
crease the  irritability  of  the  whole  nerve  trunk  to  such  a 
delicate  point  that  the  slightest  stimulation  made  at  any 
point  along  the  course  of  the  nerve  will  excite  its  inhibitory 
action.  Many  osteopaths,  just  starting  in  practice,  have 
had  their  self-possession  severely  tried  by  a  patient  faint- 
ing during  manipulation  of  the  neck.  I  have  never  heard 
of  any  fatal  results  from  manipulation  of  the  pneumogas- 
tric. Why  stimulation  of  the  pneumogastric  should  result 
in  cardiac  inhibition  rather  than  in  phenomena  connected 
with  its  other  branches  seems  incapable  of  explanation. 


156  PRINCIPLES  OF  OSTEOPATHY 

Sometimes  spasm  of  the  laryngeal  muscles  will  accompany 
cardiac  inhibition. 

The  intensity  of  action  of  the  pneumogastrics  is  so 
well  known  to  experienced  osteopaths  that  they  are  careful 
to  test  its  irritableness  in  cases  before  undertaking  any 
extensive  manipulations  along  its  course. 

The  inhibitory  center  is  continually  active  and  acts 
according  to  the  blood  pressure  within  the  arteries.  A  rise 
in  peripheral  resistance  causes  a  decrease  in  number  and 
strength  of  the  heart  beats. 

Accelerator  Center. — The  accelerator  center  is  con- 
nected with  the  heart  by  fibers  which  descend  in  the  cord 
to  the  upper  portion  of  the  dorsal  region  ;  here  connection 
is  made  with  the  cells  whose  fibers  pass  to  the  sympathetic 
spinal  ganglia,  first,  second  and  third  dorsal,  and  end  there 
around  other  cells  whose  fibers  convey  their  impulses  to 
the  heart. 


FIG.  25.     Sphygmograms  illustrating  the  effect  of  inhibition,  first,  second 
and   third  dorsal. 


The  action  of  the  accelerator  center  is  not  so  readily 
demonstrated  as  is  the  case  with  the  inhibitory  center.  It 
causes  the  heart  to  beat  faster  and  stronger,  thus  bringing 
about  a  rise  in  arterial  blood  pressure  and  a  fall  in  venous 
pressure.  This  center  acts  in  response  to  lowered  per- 
ipheral resistance.  The  products  of  metabolism  brought 
about  by  physical  exercise  also  excite  it.  Deep,  steady 
pressure  made  on  the  muscles  lying  on  each  side  of  the 
first,  second  and  third  dorsal  spines  causes  a  decrease  in  the 
rapidity-  of  the  heart's  action. 


PRINCIPLES  OF  OSTEOPATHY 


157 


FIG.    26.     Vaso-constrictor  area,    second   dorsal   to   second   lumbar. 


158  PRINCIPLES  OF  OSTEOPATHY 

Stimulation  of  the  Heart. — A  make  and  break  pressure 
made  at  the  edge  of  the  sternum  in  the  first  and  second 
intercostal  spaces  will  usually  stimulate  the  heart.  Some- 
times the  first  effect  is  inhibition,  but  it  quickly  passes  to 
stimulation.  The  manipulation  made  anteriorly  increases 
the  number  and  intensity  of  the  stimuli  reaching  the  seg- 
ment of  the  cord  from  which  the  accelerator  nerves  pass 
out.  All  centers  act  according  to  the  sum  of  the  stimuli 
reaching  them  from  all  sources. 

Inhibition  of  the  Heart. — In  cases  of  rapid  heart  beat 
with  high  tension  pulse  the  best  effects  are  secured  by 
digital  pressure  at  first,  second  and  third  dorsal  spines.  The 
pneumogastrics  have  too  many  branches  to  important  vis- 
cera and  act  frequently  with  unexpected  intensity.  The 
accelerators  act  more  slowly  with  less  intensity  and  the 
action  is  sustained  longer,  that  is,  as  a  result  of  man- 
ipulation. 

Vaso-motor  Control  of  the  Coronary  Arteries. — A  fur- 
ther factor  in  relation  to  the  regulation  of  the  heart's  action 
is  the  blood  supply  for  the  nourishment  of  the  heart.  All 
organs  act  with  greater  force  when  their  blood  supply  is 
abundant.  The  heart  beats  stronger  when  its  coronary 
arteries  are  dilated  than  when  constricted,  therefore  the 
power  of  the  heart  depends  on  the  vaso-motor  control  of 
its  own  arteries.  The  vaso-motor  nerves  to  the  coronary 
arteries  leave  the  cerebro-spinal  system  between  the  third 
and  fifth  dorsal  spines.  In  cases  of  angina  pectoris,  this 
area  will  be  sensitive.  Steady  pressure  here  will  dilate  the 
coronary  arteries  and  ease  the  pain.  A  sharp  stroke  with 
the  hypothenar  eminence  on  the  fourth  dorsal  spine  will 
nearly  always  start  an  attack  with  such  patients. 

Angina  Pectoris. — Physiologists  name  the  pneumogas- 
tric  nerve  as  the  vaso-motor  nerve  to  the  coronary  arteries. 
I  mention  the  area,  third  to  fifth  dorsal,  as  a  vaso-motor 
center  for  the  coronary  arteries  because  clinical  experience 
seems  to  demonstrate  it.  Other  osteopaths  have  noted 
the  frequency  of  lesions  in  this  area  in  connection  with 


PRINCIPLES  OF  OSTEOPATHY  159 

heart  difficulties.  The  lesions  are  contracted  muscles,  lat- 
eral subluxations  of  the  vertebrae  or  in  some  instances 
subluxations  of  the  fourth  and  fifth  ribs.  With  any  of 
these  lesions  there  is  intense  sensitiveness. 

Dr.  George  Keith  of  Scotland  mentions  digital  pres- 
sure in  the  second  left  intercostal  space  as  a  means  of  in- 
hibiting an  attack  of  angina  pectoris,  and  suggests  the 
nerve  connection  of  the  pneumogastric  as  being  the  nerve 
path  over  which  the  inhibitory  impulse  travels. 

Persons  suffering  with  angina  pectoris  will  press  their 
hands,  with  all  the  force  they  possess,  against  the  left 
chest.  I  have  used  heavy  digital  pressure  on  the  left  side 
of  the  fourth  and  fifth  dorsal  spines  while  the  patient  was 
in  a  paroxysm  of  pain.  The  pressure  never  failed  to  be 
grateful  to  the  patient.  A  further  experiment  with  this 
center  was  made  by  extending  the  patient  in  a  recumbent 
position.  While  extension  was  maintained  the  angles  of 
the  ribs  could  be  raised,  the  left  arm  could  be  extended 
over  the  head,  a  full  inspiration  could  be  taken,  but  as 
soon  as  the  vertebrae  were  allowed  to  approximate  as  a 
result  of  cessation  of  extension,  these  things  could  not 
be  done. 

Heat,  digital  pressure  and  counter  irritation  are  capa- 
ble of  causing  vaso-constrictor  paralysis,  i.  e.,  vaso-dilation, 
and  hence  increase  the  power  of  the  heart  in  such  cases. 

Action  of  the  Heart  Centers. — The  governing  centers 
of  the  heart  act  principally  according  to  the  peripheral 
resistance  maintained  by  the  blood  vessels.  The  heart  pos- 
sesses a  nerve  called  the  depressor  nerve.  Its  endings  are 
in  the  walls  of  the  heart  and  are  affected  by^the  pressure 
of  the  blood  within  the  heart.  A  rise  in  arterial  pressure 
is  followed  by  a  rise  in  pressure  within  the  heart.  The 
depressor  nerve  notes  this  fact  and  carries  an  inhibitory 
impulse  to  the  vaso-dilator  center  in  the  medulla,  thus 
bringing  about  a  fall  in  arterial  pressure.  In  this  way  the 
heart  is  protected  from  over-exertion  as  a  result  of  too 
high  pressure. 


160  PRINCIPLES  OF  OSTEOPATHY 

In  cases  having  rapid,  weak  heart  action,  inhibit  the 
accelerators  to  slow  the  heart,  also  inhibit  in  the  area  of 
vaso-motor  control  of  the  coronary  arteries  to  increase 
the  amount  of  blood  for  nourishment  to  the  heart  muscle, 
thus  increasing  the  strength  of  the  beat. 

In  cases  of  rapid,  high  tension  pulse,  inhibit  the 
splanchnics  and  in  the  suboccipital  fossae  to  lessen  peri- 
pheral resistance,  also  inhibit  the  accelerators  or  stimulate 
the  pneumogastrics. 

Vaso-motor  Nerves. — In  1840  Henle  discovered  and 
demonstrated  the  muscular  coat  of  the  arteries,  and  as  a 
result  of  this  step  forward  we  have  our  present  knowledge 
of  the  vaso-motor  nerves.  Associated  with  the  demonstra- 
tion of  these  nerves  we  have  the  names  of  Brown-Sequard, 
Bernard,  Waller  and  Schiff. 

It  has  been  proven  that  two  sets  of  fibers  innervate 
the  muscles  of  the  arteries;  a  vaso-constrictor  set,  which 
causes  a  decrease  in  the  caliber;  and  a  vaso-dilator  set 
which  causes  an  increase  in  caliber.  The  constrictors 
were  demonstrated  first. 

Henle  said  "the  movement  of  the  blood  depends  on  the 
heart,  but  its  distribution  depends  on  the  vessels."  We 
have  followed  the  phenomena  in  connection  with  the  first 
part  of  this  quotation,  hence  it  remains  for  us  to  study  the 
part  played  by  the  vessels  in  the  distribution  of  the  blood. 

In  order  to  carry  our  thoughts  along  in  a  proper  man- 
ner, we  will  commence  at  the  center  and  work  toward  the 
periphery. 

The  chief  vaso-motor  center  is  in  the  medulla.  De- 
struction of.  this  center  causes  an  immediate  fall  of  blood 
pressure  all  over  the  body.  Stimulation  of  this  center 
causes  a  general  rise  of  blood  pressure. 

There  are  subsidiary  centers  situated  at  various  levels 
in  the  spinal  cord. 

After  the  spinal  cord  is  severed,  that  portion  which  is 
no  longer  connected  with  the  chief  vaso-motor  center  will 
exercise  a  vaso-constrictor  influence  over  the  blood  vessels 


PRINCIPLES  OF  OSTEOPATHY  161 

in  its  area  of  normal  control.  "It  is  probable  that  they  are 
normally  subordinate  to  the  bulbar  nerve  cells." 

After  all  connection  between  the  cerebro-spinal  sys- 
tem and  sympathetic  spinal  ganglia  is  cut  off,  the  tone  of 
the  blood  vessels  is  maintained,  after  a  short  interval,  by 
the  sympathetic  ganglia. 

By  commencing  at  the  center  and  destroying  it,  then 
the  centers  in  the  spinal  cord  assume  control;  destruction 
of  these  leaves  the  sympathetic  spinal  ganglia  active;  hence 
by  this  process  of  exclusion  we  find  that  the  true  vaso- 
motor  cells  are  sympathetic  and  lie  in  the  spinal  ganglia. 
From  these  cells  in  the  spinal  ganglia-axis  cylinder  pro- 
cesses pass  as  gray  fibers  to  blood  vessels.  These  ganglia 
cells  are  controlled  by  fibers  from  the  chief  vaso-motor 
center  in  the  medulla  which  end  around  the  subsidiary  cells 
in  the  spinal  cord,  the  neuraxons  of  "these  latter  terminat- 
ing by  filaments  which  surround  the  true  vaso-motor  cells 
in  the  sympathetic  spinal  ganglia. 


FIG.  27.  Arterial  tension  is  manifested  in  a  sphygmogram  by  the  rela- 
tive height  of  the  aortic  notch.  The  upper  tracing  shows  the  aortic 
notch  on  a  straight  line  drawn  from  the  top  of  one  percussion  wave 
to  the  bottom  of  the  next.  The  middle  tracing  shows  this  notch 
very  low. 


Since  gray  rami-communicantes  pass  from  the  spinal 
sympathetic  ganglia  to  the  spinal  nerves  and  are  distributed 
with  them  to  the  skin  and  blood  vessels,  we  can  influence 
the  distribution  of  the  blood  generally  and  locally  by  in- 
creasing or  decreasing  the  number  of  sensory  impulses, 
originating  in  the  skin  and  muscle,  which  may  reach  the 
vaso-motor  centers. 


162  PRINCIPLES  OF  OSTEOPATHY 

"The  vaso-motor  apparatus  consists,  then,  of  three 
classes  of  nerve  cells.  The  cell  bodies  of  the  first  class  lie 
in  sympathetic  ganglia,  their  neuraxons  passing  directly 
to  the  smooth  muscle  in  the  walls  of  the  vessels;  the  second 
are  stimulated  at  different  levels  in  the  cerebro-spinal  axis, 
their  neuraxons  passing  hence  to  the  sympathetic  ganglia 
by  way  of  spinal  and  cranial  nerves;  and  the  third  are 
placed  in  the  bulb  and  control  the  second  through  intra- 
spinal  and  intracranial  paths.  .The  nerve  cell  of  the  first 
class  lies  wholly  without  the  cerebro-spinal  axis,  the  third 
wholly  within  it,  while  the  second  is  partly  within  and  part- 
ly without,  and  binds  together  the  remaining  two."  Am. 
Text-book  of  Physiology. 


FIG.  28.  The  signification  of  a  sphygmogram.  The  space  S  is  the  period 
of  ventricular  systole  when  the  aortic  valves  are  open;  the  space  D 
the  period  of  ventricular  diastole;  t.  the  tidal  wave  due  to  the  ven- 
tricular systole;  p,  the  percussion  wave  due  to  instrumental  defect; 
a  is  the  aortic  notch  which  marks  the  closure  of  the  aortic  valves; 
d,  the  dicrotic  wave. 

Vaso-constriction. — The  vaso-constrictor  nerves  which 
pass  from  the  bulbar  and  spinal  centers  of  control  leave  the 
cord  as  white  rami-communicantes  from  the  anterior  roots 
of  the  second  dorsal  to  the  second  lumbar  nerves  and  enter 
the  sympathetic  ganglia  to  be  distributed  as  has  been  de- 
scribed before.  It  is  believed  that  all  of  these  vaso-con- 
strictor fibers  end  in  the  ganglia,  thus  exerting  their  influ- 
ence on  the  true  vaso-motor  cells  in  the  ganglia  which 
alone  send  fibers  to  the  blood  vessels.  All  these  constric- 
tor nerves  are  gray. 

Vaso-dilation. — The  vaso-dilator  fibers  are  not  re- 
stricted to  any  one  portion  of  the  cord  or  brain,  but  pass 
out  with  both  cranial  and  spinal  nerves,  and  do  not  lose 
their  sheaths  until  they  reach  their  destination.  They 


PRINCIPLES  OF  OSTEOPATHY  163 

are  best  demonstrated  in  those  regions  of  the  cerebro-spinal 
system  from  which  vaso-constrictors  do  not  arise.  The 
vaso-dilators  from  the  head,  face,  salivary  glands,  etc.,  pass 
to  their  destination  with  the  cranial  nerves  supplying  these 
parts.  They  do  not  end  in  the  sympathetics.  They  proba- 
bly leave  the  cord  in  the  anterior  roots  of  the  spinal  nerves 
and  pass  to  the  periphery  without  interruption.  The  vaso- 
dilators, leaving  the  cord  in  the  same  region  as  the  vaso- 
constrictors to  be  distributed  to  the  visceral  blood  vessels 
probably  pass  out  by  the  ventral  roots  and  reach  their 
destination  without  losing  their  sheaths  in  the  sympathetic 
ganglia. 


FIG.  29.  Sphygmograms  illustrating  Tachycardia  and  Brachycardia.  Up- 
per tracing — radial  pulse  of  a  woman  exhibiting  great  nervousness,  a 
small  goitre  but  no  exophthalmos.  Lower  tracing — radial  pulse  of  a 
young  man  whose  power  of  recalling*  past  events  of  his  life  was 
suddenly  lost.  Result  of  mental  shock. 

No  distinct  centers  for  vaso-dilator  fibers  have  been 
demonstrated.  They  probably  arise  from  segments  of  the 
brain  and  spinal  cord  and  their  influence  is  carried  along 
the  paths  of  motor  nerves  and  is  exerted  in  a  local  area. 

Summary. — 1.  The  vaso-dilator  nerves  are  cerebro- 
spinal  ;  (a)  and  are  not  demedullated  in  the  sympathetic 
ganglia,  (b)  They  are  distributed  principally  to  the  ar- 
teries of  the  muscles,  (c)  and  leave  the  cerebro-spinal  axis 
with  the  motor  nerves  from  all  portions,  (d)  Their  influ- 
ence is  local. 

2.  The  vaso-constrictors  are  essentially  neuraxons  of 
sympathetic  cells  in  the  spinal  ganglia;  (a)  are  gray  fibers; 

(b)  are  distributed  to  viscera  and  cutaneous  blood  vessels; 

(c)  and  are  probably  continuous  in  action  to  maintain  the 


164  PRINCIPLES  OF  OSTEOPATHY 

tone  of  the  vascular  system,  (d)  The  vaso-motor  cells  in 
the  sympathetic  ganglia  can  act  independently,  (e)  but  are 
normally  under  the  control  of  the  cells  in  the  spinal  cord 
whose  neuraxons  end  in  the  spinal  ganglia,  (f)  These 
cells  in  the  spinal  cord  are  under  the  influence  of  neuraxons 
of  cells  in  the  medulla  which  constitute  the  chief  vaso- 
motor  center,  (g)  Therefore,  the  vaso-constrictor  influ- 
ence is  both  local  and  general,  (h)  The  controlling  fibers 
leave  the  cord  in  the  ventral  roots  of  the  second  dorsal  to 
the  second  lumbar  nerves  only. 

Sensory  Nerves. — We  have  now  considered  in  detail 
only  one  side  of  the  vaso-motor  mechanism,  the  motor. 
We  have  yet  to  note  the  sensory  side,  that  which  calls  forth 
the  motor  response.  If  there  were  no  chief  or  spinal  vaso- 
motor  centers  to  transfer  sensory  impulses  to  the  vaso-con- 
strictor cells  in  the  spinal  ganglia,  the  blood  vessels  in  the 
viscera  and  skin  could  not  contract  or  relax  according  to 
the  necessity  for  greater  or  lesser  amounts  of  heat  in  the 
deep  or  superficial  areas. 

The  vaso-motor  centers  in  the  brain  and  cord  send 
out  impulses  in  response  to  sensory  stimulation;  this  sen- 
sory stimulation  is  usually  of  a  thermal  or  mechanical 
character. 

It  is  difficult  to  realize  the  extent  of  the  distribution 
of  sensory  nerves.  "They  are  located  not  only  in  those 
places  usually  known  to  be  sensitive,  but  also  in  all  other 
tissues  and  organs.  Whether  one  examine  the  liver  or  the 
kidney,  lung  or  the  wall  of  a  blood  vessel,  one  always  finds 
delicate  nerve  arborizations  in  unsuspected  numbers.  A 
large  portion  of  them  end  probably  in  the  peripherally 
placed  end  cells  belonging  to  the  reflex  arc  of  the  sympa- 
thetic ;  another  portion  may  very  probably  be  traced  to 
the  spinal  ganglia,  and  even  to  the  spinal  cord  itself,  es- 
pecially the  investigations  of  the  past  two  years,  making 
use  of  the  silver  and  methyl  blue  stains,  have  not  only  dis- 
closed the  wealth  of  nerves  in  the  different  organs,  but 
have  also  shown  that  we  have  regarded  the  sensory  in- 


PRINCIPLES  OF  OSTEOPATHY  165 

nervation  of  the  sensitive  surfaces,  as  the  skin  and  the 
gustatory-mucous  membrane  as  much  less  fully  explained 
than  they  really  are.  One  finds  there  numerous  plexuses 
of  nerve  fibers  beneath  and  between  the  epithelial  cells, 
and  they  send  one,  often  many,  fine  fibrils  to  each  cell." 
*  "In  the  liver,  too,  and  the  bladder,  and  many 
other  places,  one  can  find  numerous  examples  of  the  abun- 
dant peripheral  innervation.  We  have  always  given  too 
great  importance  to  the  single  end  apparatus,  overlooking 
the  fact  that  really  the  major  portion  of  the  body  tissues  is 
supplied  with  nerves  for  every  cell.  One  can  hardly  over- 
estimate the  wealth  of  nerve  fibers  in  the  end  organs  them- 
selves, as  the  taste  papillae  and  the  tactile  papillae.  Good 
staining  discloses  with  each  of  them  plexuses  of  unexpected 
density  of  arborization." 

"For  what  services  may  such  an  abundant  sensory 
innervation  be  provided?  It  occurs  immediately  to  one 
that  there  are  a  great  number  of  reflexes,  very  necessary  to 
the  preservation  of  the  individual,  even  though  he  be  un- 
aware of  them.  The  regulation  of  the  secretions,  the  blood 
supply  to  the  skin  in  relation  to  the  caloric  body  economy 
of  the  organism,  the  adjustment  to  varying  illumination, 
the  tension  of  the  muscles  and  tendons  through  the  re- 
spective tendon  reflexes,  the  different  response  by  such 
varying  tensions  according  to  the  intensity  of  the  volun- 
tary impulse,  and  many  other  phenomena  could  be  cited. 
To  all  of  them  is  necessary,  besides  the  motor  part  of  the 
reflex  arc,  a  sensory  part.  Indeed,  Exner,  to  whom  we  are 
indebted  for  indicating  the  importance  of  these  short  re- 
flex arcs  and  the  roles  they  play  in  the  organism,  has 
pointed  out  how,  in  general,  for  the  production  of  any 
movement  the  sensory  innervation  must  be  intact." 

"By  'sensory  innervation,'  however,  one  must  not  think 
only  those  processes  are  meant  which  enter  into  our  con- 
sciousness, but  rather  all  those  by  which  from  any  place 
in  the  body  impressions  are  conducted  to  the  nearest  gan- 
glion, or  to  the  central  axis.  Whether  they  be  conducted 


166  PRINCIPLES  OF  OSTEOPATHY 

farther  still,  or  whether  they  be  recognized  by  the  in- 
dividual as  they  occur  does  not  affect  their  nature.  Sen- 
sation and  perception  are  not  the  same  thing." — Anatomy 
of  the  Central  Nervous  System  in  Man  and  in  Vertebrates 
in  General. — Edinger. 

Thus  we  find  that  there  are  abundant  sensory  nerves 
in  superficial  and  deep  tissue  to  receive  the  mechanical 
stimuli  which  the  osteopath  may  project  upon  them. 

Recent  investigations  prove  that  many  conditions 
which  have  previously  been  called  inflammation  are,  in 
reality,  congestions  due  to  vaso-constrictor  paralysis,  and 
can  be  corrected  by  stimulation  of  the  vaso-constrictor 
center  governing  the  congested  area;  the  stimulation  of 
such  center  being  secured  by  mechanical  stimuli  applied  to 
the  sensory  nerves  ending  in  the  center. 

The  vaso-motor  mechanism  responds  quickly  to  osteo- 
pathic  manipulation,  and  is  our  means  of  correcting  any 
disturbance  of  circulation,  both  local  and  general. 

Since  the  blood  carries  the  nourishment  for  the  tis- 
sues, and  the  vaso-motors  control  the  distribution  of  the 
blood,  the  vaso-motor  nerves  are  trophic  nerves.  In  the 
same  sense  they  are  secretory  nerves. 

Capillary  Circulation. — The  capillary  circulation  is  de- 
pendent on  the  state  of  the  arterioles.  Their  walls  are 
formed  by  endothelial  cells  which  are  elastic,  and  hence 
respond  to  the  force  of  the  blood  which  enters  them.  If 
the  vaso-constrictors  are  active  in  a  local  area  the  re- 
sistance offered  to  the  passage  of  the  blood  current  by  the 
arterioles  is  increased,  and  therefore  the  pressure  exerted 
on  the  capillary  walls  is  lessened,  allowing  the  capillaries 
to  contract.  If  the  vaso-constrictor  influence  over  the 
arterioles  be  lessened,  the  blood  current  is  allowed  to  exert 
its  pressure  on  the  capillary  walls,  thus  increasing  the 
caliber  of  the  capillary. 

If,  in  a  large  area  of  the  body,  vaso-constrictors  are 
active,  the  influence  of  this  resistance  is  felt  by  the  heart, 
which  immediately  beats  harder  to  overcome  the  resistance 


PRINCIPLES  OF  OSTEOPATHY  167 

to  the  passage  of  the  blood  through  the  constricted  arteries. 
The  heart  is  usually  relieved  by  compensatory  dilatation 
of  the  arteries  in  some  other  area.  The  visceral  and  cu- 
taneous arteries  usually  counter-balance  each  other  in  this 
way.  This  counter-balancing  effect  is  probably  brought 
about  through  the  sensory  impressions  sent  out  from  an 
overworked  heart  to  the  vaso-motor  center,  thus  causing 
a  lessened  constrictor  effect  in  some  portions  of  the  body. 

The  relaxation  of  all  the  arteries  of  the  body  would 
cause  death,  because  the  blood  would  gravitate  to  the  most 
dependent  part,  and  there  is  not  blood  enough  to  fill  all 
the  arteries  when  relaxed.  A  slight  relaxation  of  general 
blood  pressure  causes  the  heart  to  beat  more  rapidly  for 
a  short  time.  Relaxation  of  the  peripheral  blood  vessels 
is  noted  by  the  increased  warmth  and  redness -of  the  area 
in  which  relaxation  takes  place. 

Recapitulation. — To  recapitulate:  (1)  Capillary  circu- 
lation is  passive.  (2)  Vaso-constriction  of  the  arterioles 
causes  a  decrease  in  the  lumen  of  the  capillary.  (3)  Vaso- 
dilation  of  the  arterioles  causes  increase  in  the  lumen  of 
the  capillary.  (4)  General  vaso-constriction  of  the  cu- 
taneous blood  vessels  slows  the  heart  and  causes  it  to  work 
against  higher  pressure,  but  the  heart  is  relieved  by  relaxa- 
tion of  blood  vessels  in  visceral  areas,  chiefly  the  splanch- 
nics.  (5)  Decrease  of  constrictor  effect  on  superficial  ves- 
sels causes  a  more  rapid  heart  beat,  which  is  quickly  con- 
trolled by  constriction  in  the  splanchnic  area.  (6)  The 
vaso-motor  center  in  the  medulla  acts  according  to  the 
sum  of  the  sensory  influences  reaching  it  from  all  parts  of 
the  body.  (7)  The  spinal  vaso-motor  centers  act  according 
to  the  influences  sent  to  them  by  the  chief  center  and  the 
sensory  impulses  which  enter  their  segment  of  the  cord. 

Vaso-motor  Centers. — The  vaso-motor  centers  for  the 
various  viscera,  organs  and  members  are  as  follows : 

HEAD:  The  superior  cervical  ganglion. 

EYE :  The  superior  cervical  ganglion  through  the  fifth 
nerve. 


168  PRINCIPLES  OF  OSTKOPATHY 

NOSE,  THROAT,  TONSILS,  TONGUE  and  GUMS: 
By  the  same  path.  Dilator  fibers  for  the  tongue  per  the 
lingual  branch  of  the  fifth  cranial  nerve. 

BRAIN:  "Sherrington  and  others  have  demonstrated 
the  presence  of  vaso-motor  nerves  in  the  vessels  of  the 
brain.  It  is  probable  that  the  cerebral  circulation  is  wholly 
dependent  upon  the  general  blood  pressure,  and,  inasmuch 
as  the  general  blood  pressure  is  very  markedly  regulated 
by  the  capacious  splanchnic  area,  it  is  obvious  that  the 
cerebral  circulation  may  be  better  controlled  by  modifying 
the  blood  supply  of  the  splanchnic  area  than  by  any  at- 
tempts at  the  modification  of  the  cerebral  circulation  itself." 

Sympathetic  fibers  to  the  anterior  and  middle  fossae 
come  from  the  superior  cervical  ganglion  per  the  carotid 
plexus.  Sympathetic  fibers  are  distributed  to  the  vessels 
in  the  posterior  fossa  from  the  vertebral  plexus  which  is 
formed  by  fibers  from  the  inferior  cervical  ganglion. 

THYROID  GLAND:  Middle  and  inferior  cervical 
ganglion. 

The  vasoconstrictors  for  the  blood  vessels  of  the  head, 
face  and  neck  with  their  contained  organs  leave  the  spinal 
cord  in  the  upper  dorsal,  second  to  fifth,  and  pass  thence 
through  the  cervical  ganglion. 

LUNGS:  Second  to  the  sixth  dorsal. 

INTESTINES:  The  vaso-constrictors  for  the  mesen- 
teric  blood  vessels  are  found  in  the  splanchnic  nerves.  Com- 
mencing at  the  fifth  dorsal,  there  is  a  segmental  distribution 
to  the  various  portions  of  the  intestines.  The  lowest  con- 
strictor influence  comes  from  the  second  lumbar.  Vaso- 
dilator fibers  are  also  found  in  the  splanchnics. 

LIVER:  Sixth  to  tenth  dorsal,  right  side. 

KIDNEY:  Tenth  to  twelfth  dorsal. 

SPLEEN  :  Ninth,  tenth  and  eleventh  dorsal,  left  side. 
The  vagus  is  a  motor  nerve  to  the  muscular  fibers  in  the 
trabeculae  of  the  spleen. 

PORTAL  SYSTEM :  Fifth  to  ninth  dorsal. 


PRINCIPLES  OF  OSTEOPATHY  169 

EXTERNAL  GENERATIVE  ORGANS:  First  and 
second  lumbarr  through  the  lumbar  sympathetic  ganglia, 
second  to  the  fifth,  to  the  hypogastric  plexus,  thence 
through  the  pelvic  plexuses  and  pudic  nerves  to  the  gen- 
erative organs.  Function,  vaso-constriction.  First,  second 
and  third  sacral  nerves  are  vaso-dilators  to  the  same  organs. 

INTERNAL  GENERATIVE  ORGANS:  Vaso-con- 
strictor  influence  at  first  and  second  lumbar. 

ARTERIES  TO  THE  SKIN  OF  THE  BACK:  Vaso- 
constrictor influence  from  sympathetic  ganglion  of  the  cor- 
responding segment. 

UPPER  EXTREMITY:  Vaso-constrictor  influence  to 
the  skin,  from  second  to  the  seventh  dorsal. 

LOWER  EXTREMITY:  Sixth  dorsal  to  second  lum- 
bar. 

MUSCLES :  Dilator  influence  to  the  arteries  of  the 
muscles  per  motor  nerves  to  the  muscles. 

Conclusions. — Vaso-motor  nerves  are  of  two  classes, 
viz :  Vaso-constrictor  and  vaso-dilator.  These  nerves  act 
according  to  the  sum  of  the  stimuli  reaching  their  govern- 
ing center  over  sensory  nerves  of  skin,  muscle  and  gland. 
Therefore  the  osteopath  depends  on  increasing  or  decreas- 
ing the  stimuli  reaching  the  spinal  centers. 

The  heart  is  innervated  by  two  sets  of  nerves  which 
control  it.  These  nerves  arise  from  centers  in  the  cerebro- 
spinal  system  and  govern  the  action  of  the  heart  according 
to  the  sum  of  stimuli  reaching  their  centers  over  sensory 
nerves  of  skin,  muscle  and  gland,  and  in  harmony  with 
the  resistance  maintained  by  the  peripheral  blood  vessels. 

Since  perivascular  tissues  are  dependent  on  the  trans- 
fusion of  nutriment  from  the  blood,  through  the  walls  of 
the  capillaries  into  the  lymph,  and  this  process  of  trans- 
fusion is  dependent  on  the  tension  and  speed  of  the  cur- 
rent of  blood  in  the  capillaries,  any  condition  which 
markedly  increases  or  decreases  this  speed  and  tension 
will  affect  the  nourishment  of  the  tissues. 


170  PRINCIPLES  OF  OSTEOPATHY 

Hyperaemia. — A  study  of  hyperaemia  is,  in  reality,  a 
study  of  the  vaso-motor  mechanism.  We  .have  noted  the 
fact  of  vaso-motor  nerves  controlling  the  caliber  of  blood 
vessels.  These  nerves  are  branches  of  the  cerebro-spinal 
system.  Most  of  them  leave  the  spinal  nerves  and  pass  to 
the  sympathetic  spinal  ganglia  as  rami-communicantes  and 
then  pass  up  and  down  to  other  ganglia  of  the  sympathetic 
system.  Some  fibers  return  from  the  sympathetic  to  the 
spinal  nerves  and  are  distributed  to  blood  vessels  of  skin, 
muscle  and  bone  in  the  area  of  distribution  of  the  spinal 
nerves.  A  few  vaso-motor  nerves  do  not  enter  the  sympa- 
thetic system  but  pass  directly  tc  their  destination  with 
the  spinal  nerves.  Thus  two  paths  exist  by  which  vaso- 
motor  impulses  reach  the  blood  vessels,  a  direct  route  with 
the  spinal  nerves  and  an  indirect  one  through  the  sympa- 
thetics. 

Experimenters  have  long  noted  the  return  of  vascular 
tone  in  an  area  whose  vaso-constrictor  nerves  have  been 
cut.  This  return  of  vascular  tonicity  is  supposed  to  be 
due  to  the  presence  of  a  perivascular  mechanism  which 
is  capable  of  acting  feebly  after  all  other  constrictor  in- 
fluences have  been  paralyzed. 

So  far  as  methods  of  treatment  are  concerned,  we  have 
paid  very  little  attention  to  the  presence  of  vaso-dilator 
nerves,  but  physiologists  seem  to  prove  that  there  are  fibers 
leaving  the  cord  with  the  posterior  roots  of  the  nerve  trunks 
which  act  as  dilators  when  irritated.  The  vaso-constric- 
tor nerves  are  considered  as  constantly  in  action. 

Irritation  of  the  dilator  nerves  or  paralysis  of  the  con- 
strictors will  result  in  dilatation  of  the  arterioles,  so  that 
the  capillaries  will  be  dilated  to  their  fullest  extent.  Such 
a  condition  is  called  an  "active  hyperaemia."  When  the 
exit  of  the  blood  through  the  veins  is  obstructed  and  con- 
gestion results  it  is  denoted  "passive  hyperaemia." 

The  same  irritants,  mechanical,  thermal  and  chemical, 
which  are  capable  of  stimulating  muscles  to  unusual  or  un- 
equal contractions  so  as  to  produce  marked  evidences  of 


171 

changed  bony  alignment,  also  cause  such  decided  changes 
in  the  caliber  of  blood  vessels  as  to  cause  tissues  to  be- 
come hyperaemic  or  ischaemic. 

If  any  hyperaemia  exists  in  the  mucosa  of  the  stomach, 
palpation  around  the  sixth  dorsal  spine  will  disclose  ten- 
derness. This  spinal  tenderness  is  probably  due  either  to 
the  irritation  of  the  dilator  fibers  which  accompany  the 
posterior  division  of  the  fifth  dorsal  nerve  or  to  paralysis 
of  the  vaso-constrictors  of  that  area.  The  resulting  dila- 
tation impinges  on  sensory  nerves  and  causes  tenderness. 
The  irritation  of  sensory  nerves  in  the  mucosa  of  the 
stomach  causes  dilatation  of  blood  vessels  in  that  area 
and  in  the  spinal  area  from  which  its  sensory  nerves  arise. 
The  irritation  might  have  originated  centrally  and  then  in- 
volved the  stomach,  thus  reversing  the  course  of  the  irrita- 
tion. These  reflex  hyperaemias  are  continually  noted  in 
practice,  and  it  is  through  the  reflexes  that  relief  is  ob- 
tained. One  of  the  classical  experiments  to  prove  the  re- 
flex action  of  vaso-motor  nerves  is  to  immerse  one  hand 
in  cold  water,  the  temperature  of  the  other  hand  will  be 
lowered  also. 

It  is  quite  generally  conceded  that  the  small  arteries 
and  arterioles  in  all  parts  of  the  body  are  supplied  with 
vaso-motor  nerves.  Their  presence  in  the  blood  vessels  of 
the  brain  has  been  recently  proven  by  G.  C.  Huber.  His 
demonstration  of  vaso-motor  nerves  in  the  cerebral  blood 
vessels  explains  many  of  the  circulatory  phenomena  result- 
ing from  osteopathic  manipulations. 

Irritation  of  sensory  nerves  in  any  part  of  the  body 
causes  vascular  dilatation  in  the  irritated  area.  Physi- 
ological experiments  seem  to  prove  that  vaso-dilator  fibers 
accompany  the  sensory  nerves,  or  that  irritation  of  sensory 
.nerves  causes  paralysis  of  vaso-constrictor  nerves.  Irrita- 
tion of  the  nerves  of  one  side  of  the  body  by  pricking  with 
a  pin  causes  a  rise  of  temperature  on  that  side  and  a  de- 
crease on  the  unirritated  side,  thus  demonstrating  that 
vaso-dilation  follows  sensory  irritation. 


172  PRINCIPLES  OF  OSTEOPATHY 

Experiments  to  note  the  effects  of  direct  mechanical 
irritation  of  the  stomach  mucosa  demonstrate  that  dilata- 
tion of  gastric  blood  vessels  follows  mechanical  irritation. 
The  physiological  hyperaema  thus  produced  is  for  purposes 
of  increased  secretion.  It  is  well  known  that  when  this 
physiological  congestion  is  continued  without  cessation,  as 
in  the  case  when  meals  are  frequent  and  full,  the  con- 
gestion becomes  pathological,  and  the  secretion  of  mucus 
is  rapid.  The  liver  and  intestines  become  chronically  con- 
gested from  similar  causes.  This  hyperaemia  leads  to  ex- 
uclates  and  hyperplasia  which  further  irritates  sensory 
nerve  endings  and  continues  the  dilatation  of  the  arterioles. 
Thus  a  vicious  cycle  of  reflexes  is  established  which  tends 
to  ever  increasing  destructiveness. 

When  the  sensory  nerve  terminals  in  the  stomach  are 
irritated  and  hyperaemia  of  the  gastric  vessels  results,  the 
influence  of  the  irritation  does  not  end  with  gastric  con- 
gestion, i.  e.,  if  the  hyperaemia  be  excessive,  but  causes 
dilatation  of  arteries  in  the  spinal  cord  around  the  roots  of 
sensory  nerves  distributed  in  .other  parts  of  the  body  which 
are  supplied  by  branches  of  the  same  nerve  trunk.  The 
brain  does  not  always  note  the  real  location  of  the  irrita- 
tion. It  may  refer  the  pain  to  any  point  supplied  by  a 
branch  of  the  nerve  trunk,  one  of  whose  branches  is  irri- 
tated. Thus  in  the  presence  of  chronic  congestion  of  the 
gastric  mucosa,  as  in  gastric  catarrh,  the  irritation  may 
not  be  intense  enough  to  impress  the  brain  with  a  painful 
sensation,  but  a  slight  increase  of  capillary  pressure  around 
the  trunk  of  the  sixth  dorsal  nerve  such  as  would  be  brought 
about  by  digital  pressure  made  upon  the  muscles  around 
the  sixth  dorsal  spine,  would  cause  instant  recognition  of 
hyperaesthesia  by  the  patient.  Continued  pressure  made 
around  the  spine  drives  the  blood  out  and  lessens  the  sen- 
sitiveness. If  hyperaemia  has  been  intense  enough  to 
cause  exudates,  pressure  increases  the  pain  the  longer  it  is 
continued,  because  the  exudates  have  affected  the  venous 
circulation  and  there  is  no  open  path  for  exit  of  the  blood. 


PRINCIPLES  OF  OSTEOPATHY  173 

From  personal  experience  I  should  judge  that  it  is 
quite  probable  that  hyperaemia  occurs  along  the  whole 
course  of  the  nerve  and  the  nervi  nervorum  are  rendered 
more  sensitive  thereby.  In  case  of  absolute  neuritis,  man- 
ipulation relieves  the  condition  temporarily,  but  the  pain 
increases  shortly  after  the  treatment  is  given.  This  shows 
that  a  condition  exists  which  is  much  more  difficult  to 
change  than  a  reflex  hyperaemia. 

Continued  hyperaemic  conditions  cause  increased  nu- 
trition, i.  e.,  hyperplasia  of  connective  tissue.  Connective 
tissue  seems  to  be  more  readily  formed  than  any  of  the 
higher  grades  of  tissue.  This  may  explain  the  rapid  stif- 
fening of  the  spine  in  cases  of  visceral  hyperaemia. 

The  digital  pressure  test  is  an  excellent  method  of 
differentiating  the  intensity  of  an  hyperaemia.  Even  in 
cases  of  conscious  pain  in  the  gastric  or  intestinal  areas,  it 
is  possible  to  use  this  test.  In  colic,  deep  pressure  made 
gradually  will  give  relief,  but  in  cases  of  gastric  ulcer  or 
other  inflammatory  conditions,  pressure  aggravates  the 
pain. 

Therapeutics. — We  now  have  before  us  an  array  of 
physiological  facts  and  it  remains  for  us  to  indicate  how 
we  shall  use  them. 

The  osteopath  treats  the  vaso-motor  nerves  as  though 
there  were  no  dilator  fibers  to  be  reckoned  with.  Practically, 
we  consider  that  the  vaso-constrictors  are  continually  act- 
ing to  maintain  the  "tone"  of  the  blood  vessels.  There- 
fore, having  only  this  one  force  with  which  to  reckon,  we 
consider  all  dilatation  as  vaso-constrictor  paralysis. 

We  noted  the  fact  that  the  cutaneuos  and  visceral 
blood  vessels  were  supplied  with  vaso-constrictors  and 
that  vaso-constriction  in  the  superficial  area  was  compen- 
sated for  by  dilatation  in  the  deep  area. 

A  large  number  of  sensory  impressions  reaching  the 
vaso-motor  centers  over  the  sensory  nerves  of  the  skin 
usually  result  in  vaso-constriction  of  cutaneous  blood  ves- 


174  PRINCIPLES  OF  OSTEOPATHY 

sels,  hence  internal  congestion.  Irritation  of  the  sensory 
nerves  in  the  skin  may  cause  muscle  under  the  skin  to  con- 
tract, thus  obstructing  the  circulation  in  the  skin.  There- 
fore, our  manipulations  for  vaso-motor  effects  naturally 
divide  themselves  into  two  classes.  First,  those  which  in- 
hibit cutaneous  reflexes;  second,  those  which  relax  muscle 
in  order  to  remove  obstructions.  This  division  is  purely 
arbitrary  on  our  part,  but  it  serves  to  explain  our  work. 
We  purposely  leave  out  of  this  discussion  the  thought  that 
we  may  have  an  osseous  lesion  causing  our  vaso-motor 
disturbance.  We  divide  the  spine  into  areas  according 
to  the  predominating  influence  which  issues  from  it;  thus, 
the  sub-occipital  fossa  is  the  first  important  area.  It  has 
long  been  known  that  pressure  applied  to  this  area  in  a 
case  of  congestive  headache  gives  great  relief.  The  good 
effects  are  not  lost  when  the  pressure  is  removed.  This 
proves  that  the  effect  of  the  pressure  is  on  the  nerves  of 
that  area,  and  that  they  are  in  close  central  connection 
with  the  vaso-motor  center  in  the  medulla.  This  center 
regulates  the  caliber  of  the  arteries  all  over  the  body.  It 
has  been  stated  that  pressure  at  the  basi-occiput  retards 
the  blood  flow  to  the  brain,  the  pressure  being  on  the  ver- 
tebral arteries.  We  believe  a  careful  examination  of  the 
atlas  will  convince  one  that  in  the  average  skeleton  the 
groove  for  the  vertebral  artery  is  so  deep  and  well  pro- 
tected that  pressure  on  the  surface  of  the  neck  cannot  af- 
fect the  artery.  If  our  pressure  effect  is  mechanical,  why 
does  the  effect  last  so  long?  The  blood  stream  is  as  swift 
as  an  ocean  greyhound,  and  would  rush  into  the  partly 
filled  vessel  with  its  previous  force  just  the  moment  the 
pressure  is  removed.  We  can  only  explain  the  result  by 
noting  the  fact  that  a  change  has  been  made  in  the  entire 
circulation.  Downward  pressure  on  the  carotids  is  also 
recommended  to  retard  the  blood  flow  to  the  head.  This 
seems  impracticable  since  the  pressure  cannot  help  af- 
fecting the  venous  return  as  well  as  the  carotid  stream. 
The  best  and  most  lasting  effects  are  always  vaso-motor. 


PRINCIPLES  OF  OSTEOPATHY  175 

It  is  a  well  recognized  fact  in  the  osteopathic  profes- 
sion that  pressure  in  the  suboccipital  triangles  causes  a 
lessened  blood  pressure  all  over  the  body.  This  fact  is 
made  use  of  daily  to  lower  the  temperature  of  the  body 
in  cases  of  fever.  If  pressure  had  a  mechanical  rather 
than  a  nervous  effect  on  the  circulation,  we  could  hope 
for  no  general  effect,  such  as  we  do  secure.  This  procedure 
is  called  inhibiting  the  vaso-motor  center.  Why  does  it 
inhibit?  A  "vascular  tone"  is  normal  in  the  body  in  order 
to  keep  the  blood  equally  distributed.  This  "vascular 
tone"  is  easily  disturbed  since  it  acts  according  to  the  sum 
of  the  sensory  impulses  reaching  the  center  in  the  med- 
ulla. Pressure  in  the  suboccipital  triangles  affects  not  only 
the  sum  of  the  stimuli  reaching  the  center,  but,  most  im- 
portant of  all,  affects  the  capillary  circulation  in  this  area 
which  is  in  close  nervous  and  circulatory  connection  with 
the  medulla.  Any  external  application,  such  as  hot  or  cold 
water,  local  anaesthetics  or  counter-irritants  must  secure 
whatever  internal  change  may  be  manifested,  by  the  ef- 
fect these  therapeutic  procedures  may  have  on  cutaneous 
nerves. 

Pressure  in  the  suboccipital  triangles  will  relax  the 
structures  forming  those  triangles,  thus  lessening  the  sen- 
sory impulses  entering  the  center  from  that  source.  The 
relaxed  structures  will  hold  more  blood,  hence  they  will 
in  a  slight  degree  relieve  congestion  of  the  center. 

These  triangles  are  the  bilateral  surface  centers  in 
which  we  operate  to  cause  dilatation  of  vessels  in  the  skin 
of  the  trunk  and  extremities.  We  inhibit  vaso-constricton 
of  surface  arteries. 

The  next  great  constrictor  area  is  the  splanchnic,  sixth 
to  eleventh  dorsal.  This  and  the  preceding  area  are  the  two 
points  of  vantage  for  the  osteopath.  Since  the  splanchnic 
nerves  control  .a  system  of  blood  vessels  whose  combined 
capacity  is  equal  to  the  entire  amount  of  the  blood  in  the 
body,  we  can  quickly  realize  what  it  means  to  the  general 
circulation  to  affect  this  area.  In  all  cases  of  congestive 


176  PRINCIPLES  OF  OSTEOPATHY 

headaches,  fever,  hyperaemia  of  visceral  organs,  etc.,  we 
"inhibit  the  splanchnics."  Why?  The  reflexes  between 
the  skin  of  the  back  and  the  muscles  of  the  back  are  so 
intense  that  they  cause  vascular  constriction  of  the  cu- 
taneous arteries  and  contraction  of  the  deep  muscles  of 
the  back,  thus  adding  a  mechanical  obstruction  to  the  cir- 
culation of  the  blood  in  an  already  constricted  area.  Is 
it  not  possible,  yes,  probable,  that  this  state  of  the  surface 
tissue  causes  a  congestion  of  the  vaso-motor  centers  in 
the  dorsal  area  of  the  cord,  thus  nullifying  their  control 
of  the  splanchnic  area?  Such  a  condition  might  be  brought 
about  by  cold.  The  eating  of  indigestible  food  which  re- 
mains a  long  time  in  the  digestive  tract  may  also  be  a 
cause. 

The  facts  are  as  we  have  stated  them,  we  inhibit  over 
the  splanchnic  area  to  lessen  the  intensity  of  the  reflexes 
in  that  area,  thereby  allowing  the  centers  to  regain  their 
control.  Remember  that  inhibition  lessens  the  sensory 
impressions  reaching  a  center  and  relaxes  muscle  both 
directly  and  indirectly. 

Case  Illustrations. — An  illustration  of  osteopathic 
methods  applied  to  hyperaemia  is  afforded  by  the  following 
case :  A  gentleman  about  fifty  years  of  age  was  inspecting 
mines  in  the  vicinity  of  Yuma,  Arizona.  He  was  of  ple- 
thoric habit  and  hence  the  heat  of  that  locality  affected 
him  quickly.  About  eight  p.  m.,  while  in  his  tent  pre- 
paring to  bathe  in  order  to  get  some  relief  from  the  in- 
tense heat,  he  felt  a  wave  of  weakness  pass  up  his  left  side 
and  almost  instantly  power  of  motion  on  that  side  was 
lost.  Paralysis  did  not  extend  to  the  face.  The  gentle- 
man was  brought  to  Los  Angeles  and  came  under  the  best 
of  medical  treatment.  Electricity  and  massage  were  tried 
with  fair  success,  but  the  left  arm  and  hand  remained 
helpless  and  were  carried  in  a  sling.  The  hand  was  badly 
swollen  and  would  pit  under  pressure,  thus  showing  a 
marked  degree  of  vaso-constrictor  paralysis.  The  hand 
and  arm  had  been  thoroughly  massaged  for  two  months 


PRINCIPLES  OF  OSTEOPATHY  177 

before  osteopathic  treatment  was  given.  One  hour's  seance 
with  the  masseur  would  make  a  wonderful  change  in  the 
hand,  but  the  oedematous  condition  returned  in  a  few 
hours.  The  ringers  were  bent  into  the  palm,  showing  a 
marked  tendency  to  a  spastic  condition. 

From  the  medical  standpoint  it  was  considered  suf- 
ficient for  this  case  to  have  the  local  massage  of  the  arm 
and  hand,  with  administration  of  strychnine. 

The  osteopathic  examination  was  made  at  the  end  of 
two  months  of  the  treatment  just  outlined.  Slight  signs 
of  paralysis  were  noted  at  the  angle  of  the  mouth  on  the 
hemiplegic  side.  Examination  of  the  neck  showed  marked 
contraction  of  the  deep  cervical  muscles  on  the  left  side, 
extending  from  the  occiput  to  the  fourth  cervical  vertebra. 
Moderate  digital  pressure  over  these  contracted  muscles 
caused  pain.  There  was  also  some  tenderness  as  low  as 
the  sixth  dorsal  spine.  The  intense  contraction  and  tender- 
ness in  the  upper  cervical  region  was  noted  as  a  secondary 
lesion  existing  as  a  result  of  a  blood  clot.  It  was  reasoned 
that  if  these  contracted  muscles  could  be  relaxed  cerebral 
circulation  would  be  equalized  and  more  rapid  absorp- 
tion of  the  clot  made  possible.  The  spinal  tenderness  was 
brought  about  by  the  same  law  of  irritation  of  sensory 
nerves  we  have  previously  stated.  There  was  a  dilated 
condition  of  the  arterioles  around  the  roots  of  the  sensory 
nerves  in  the  cord  similar  in  character  to  that  which  existed 
at  the  peripheral  distribution  of  these  nerves,  especially  in 
the  hand.  There  was  decided  wrist  and  elbow  reflex,  show- 
ing that  the  subsidiary  nerve  cells  in  the  cord  were  intact, 
but  that  either  the  cerebral  motor  areas  or  some  part  of 
their  connecting  paths  were  injured.  The  vascular  tone 
of  blood  vessels  in  all  other  parts  of  the  body  was  good, 
showing  that  the  chief  vaso-motor  center  in  the  medulla 
was  acting.  Here  was  a  case  showing  a  perfect  reflex  in 
the  arm  but  loss  of  ability  to  will  a  motion ;  perfect  sensa- 
tion and  vaso-motor  paralysis. 


178  PRINCIPLES  OF  OSTEOPATHY 

Treatment  was  directed  to  securing  relaxation  of  the 
contracted  cervical  muscles  and  to  breaking  up  adhesiions  in 
the  shoulder  joint  which  had  been  allowed  to  stiffen.  No 
treatment  was  given  to  the  hand  or  arm.  The  patient  was 
instructed  to  straighten  the  bent  ringers  with  the  well  hand 
many  times  per  day  to  overcome  the  spastic  condition. 
Vaso-motor  tone  returned  to  the  blood  vessels  of  the  hand 
in  proportion  to  the  amount  of  cervical  relaxation  ac- 
complished. At  the  end  of  one  month  the  hand  was  al- 
lowed to  hang  naturally,  and  scarcely  any  oedema  was 
noticeable.  Muscular  control  and  power  have  steadily 
increased. 

Another  illustration  is  afforded  by  the  following  case: 
A  gentleman  suffering  with  inflammatory  rheumatism  in 
the  second  toe  of  the  right  foot  sought  relief  by  means  of 
osteopathic  treatment.  He  had  used  the  salicylates  in  his 
previous  attacks,  but  his  stomach  had  become  intolerant  of 
them.  The  toe  was  red  and  angry  looking,  throbbing  with 
pain  and  swollen  to  the  size  of  the  great  toe. 

Examination  of  the  spine  revealed  tenderness  between 
the  fifth  lumbar  and  third  sacral  spines,  also  between  the 
second  and  third  lumbar  spines.  Why  should  tenderness 
exist  at  these  points?  The  answer  according  to  anatomy 
and  physiology  is  that  these  spinal  areas  mark  the  point  of 
emergence  from  the  spinal  column  of  the  anterior  crural 
and  great  sciatic  nerves  which  are  distributed  to  equal 
parts  of  the  affected  toe;  the  sensory  nerves  being  ir- 
ritated by  the  deposit  of  faulty  katabolic  products  in  the 
tissues  of  the  toe  as  the  result  of  a  slow  blood  stream. 
In  this  case  the  patient  was  caught  out  in  the  rain  and 
got  his  feet  wet.  The  peripheral  irritation  of  the  sensory 
nerves  caused  dilatation  of  the  arterioles  and  capillaries. 
The  blood  vessels  around  the  roots  of  other  sensory 
nerves  which  were  branches  of  the  same  nerve  trunks  also 
dilated  in  response  to  this  irritation,  i.  e.,  hyperaemia  in 
the  spinal  cord  was  brought  about  at  the  point  of  origin 


PRINCIPLES  OF  OSTEOPATHY  179 

of  the  anterior  crural  and  great  sciatic  nerves,  hence  the 
sensory  nerves  to  the  skin  and  muscles  of  the  back  which 
are  innervated  from  the  same  area  of  the  cord  as  these 
great  nerve  trunks  will  also  be  tender  to  increased  tension 
such  as  that  secured  by  the  digital  pressure. 

In  a  case  such  as  this  we  do  not  desire  to  have  the 
deposit  in  the  toe  taken  up  until  the  eliminating  organs 
of  the  body  are  acting  freely.  To  force  it  into  the  circula- 
tion before  such  time  as  it  can  be  eliminated  may  result  in 
inflaming  another  part.  It  is  quite  necessary  that  the 
throbbing  pain  be  subdued  so  that  sleep  may  be  had.  The 
patient  soon  learns  to  take  advantage  of  venous  circula- 
tion by  elevating  the  foot.  If  pressure  upon,  and  a  gentle 
relaxing  movement  of  the  muscles  in  the  spinal  area  is 
made,  there  will  quickly  be  noted  a  decrease  in  spinal 
sensitiveness  followed  by  lessened  conscious  pain  in  the 
toe.  It  is  quite  probable  that  pain  in  the  toe  is  due  to 
hyperaemia;  sensitiveness  in  the  spinal  area  is  due  to  the 
same  sort  of  condition,  the  difference  being  in  degree.  It 
is  impossible  to  prove  the  presence  of  these  transitory 
hyperaemias  by  any  direct  observations  any  more  than  it 
is  possible  to  prove  by  post  mortem  examination  that  hy- 
peraemia or  anaemia  of  the  brain  is  present  as  a  fixed 
pathological  lesion  in  faulty  functioning  of  the  brain. 

Pressure  and  relaxation  in  the  spinal  area  draws  the 
blood  away  from  its  position  around  the  nerve  trunk  roots 
and  thus  stops  many  of  the  impulses  which  would  originate 
centrally  as  a  result  of  the  irritation  of  the  sensory  roots  of 
the  nerve  trunk. 

We  usually  think  of  these  reflex  sensitive  areas  of  the 
spine  as  being  evidence  of  the  ability  of  all  the  branches  of 
a  nerve  trunk  to  express  some  degree  of  the  irritation  be- 
ing brought  to  bear  on  any  one  of  the  branches.  It  seems 
to  me  that  in  the  light  of  what  is  known  to  happen  in  the 
area  of  an  irritated  nerve,  hyperaemia,  that  the  same 
change  in  circulation  may  occur  around  the  roots  of  its 


180  PRINCIPLES  OF  OSTEOPATHY 

parent  nerve  trunk  and  be  the  sole  reason  for  what  we  de- 
nominate a  reflex  pain. 

By  giving  the  heavy  movement  required  to  replace  a 
subluxated  vertebra  or  even  to  relax  tense  muscles  around 
an  otherwise  normal  articulation,  it  is  quite  probable  that 
inexplicable  changes  are  wrought  in  the  circulation  at 
these  points  which  immediately  change  the  character  of 
the  nerve  impulses  originating  or  reflexing  from  this  por- 
tion of  the  spinal  cord. 


PRINCIPLES  OF  OSTEOPATHY  181 


CHAPTER  X. 

HILTON'S  LAW. 

In  the  years  1860-61-62  a  seres  of  lectures  was  delivered 
by  John  Hilton,  F.  R.  S.,  F.  R.  C.  S.,  "On  the  Influence  of 
Mechanical  and  Physiological  Rest  in  the  Treatment  of 
Accidents  and  Surgical  Diseases,  and  the  Diagnostic  Value 
of  Pain."  These  lectures  were  afterward  published  in  book 
form  under  the  title  of  "Rest  and  Pain."  This  book  is  a 
medical  classic  and  worthy  of  careful  perusal  by  all  stu- 
dents of  medicine. 

The  careful  observations  and  reasonings  therefrom 
which  are  reported  in  "Rest  and  Pain"  explain  many  of  the 
phenomena  noted  in  osteopathic  practice.  We  desire  to 
give  all  due  honor  to  this  man  who  was  so  far  in  advance 
of  his  time. 

We  will  quote  a  few  paragraphs  from  "Rest  and  Pain" 
which  have  a  direct  bearing  on  osteopathic  methods  of 
diagnosis  and  therapeutics. 

The  Law  Stated. — After  careful  study  of  the  distribu- 
tion of  nerves  throughout  the  body,  Hilton  sums  up  his  ob- 
servations in  a  terse  sentence  which  we  choose  to  call  a 
law :  "The  same  trunks  of  nerves  whose  branches  supply 
the  groups  of  muscles  moving  a  joint,  furnish  also  a  dis- 
tribution of  nerves  to  the  skin  over  the  insertion  of  the 
same  muscles,  and  the  interior  of  the  joint  receives  its 
nerves  from  the  same  source." 

Hilton  further  states  that  "Every  fascia  of  the  body 
has  a  muscle  attached  to  it,  and  that  every  fascia  through- 
out the  body  must  be  considered  as  a  muscle." 


182 


PRINCIPLES  OF  OSTEOPATHY 


a  Opinai     Corii 

b  pojUricrr  pnmo.ru 

I  Internal  branch.  ( 

d  External  bronchi  t(  muscular) 


i.     LatTeval    cu-Cicuvtou5 
fl.     "Recurrent     branch 
)>      Vervo.  Cairo.   Inferior. 


h-     Sy  mpathcttc 


.P 
a     tke    vvitle    ranqt?    anxi  catlmate    relatlon.5      oi 

Jtslriktttloiv  artdL  Connecttoxxs. 


FIG.   30.     Drawn  by  Dr.  J.   E.   Stuart. 


PRINCIPLES  OF  OSTEOPATHY  183 

Methods  of  Studying  Anatomy. — These  statements 
lead  us  to  a  closer  study  of  each  joint  and  its  controlling 
muscles  and  governing  nerve  or  nerves.  We  may  study 
anatomy  under  artificial  divisions  such  as  Osteology,  Syn- 
desmology,  Myology,  etc.,  and  still,  after  securing  an 
accurate  technical  knowledge  of  details,  we  have  nothing 
of  practical  value.  It  is  in  the  correlation  of  these  tissues 
with  their  interdependence  quite  fully  understood  that  we 
have  a  working  knowledge.  With  this  thought  of  the  in- 
fluence of  one  tissue  on  another  and  the  harmonious  ac- 
tion secured  by  the  comparatively  varied  distribution  of 
the  nerve  trunks,  we  find  a  new  and  vital  interest  in 
anatomy. 

This  law  is  based  upon  the  facts  of  anatomy  and  physi- 
ology, and  makes  our  concrete  knowledge  of  these  sub- 
jects of  constant  practical  value  in  both  diagnosis  and 
therapeutics.  This  law  shows  us  the  "why"  of  certain  vital 
and  mechanical  manifestations,  and  teaches  us  practical 
methods  of  treatment. 

Example  of  Hilton's  Law. — An  example  of  Hilton's 
law  is  the  distribution  of  the  sciatic  nerve  to  the  ankle. 
The  muscles  moving  the  joint,  the  synovial  membrane  and 
most  of  the  skin  over  the  joint  are  all  innervated  by  it. 

The  Knee. — The  knee  has  three  nerves.  Each  one  has 
a  motor  and  sensory  control.  The  extensor  muscles  and 
the  skin  over  them  is  innervated  by  the  anterior  crural. 
The  flexor  muscles  and  the  skin  over  them  is  innervated 
by  the  sciatic.  The  obturator,  in  addition  to  these  nerves, 
furnishes  sensory  filaments  to  the  synovial  membrane.  All 
the  joints  of  the  body  may  be  examined  in  the  light  of  this 
law.  The  same  segment  of  the  central  nervous  system 
which  gives  off  a  purely  motor  nerve  trunk,  gives  off  also 
a  sensory  nerve  whose  filaments  are  distributed'  over  the 
same  area.  Thus  it  is  sometimes  necessary  to  go  to  the 
central  nervous  system  to  discover  this  association  of 
motor  and  sensory  distribution.  In  practice  we  always  do 


184  PRINCIPLES  OF  OSTEOPATHY 

this,  because  it  is  easier  to  work  from  the  center  of  the 
areas  of  distribution. 

The  Object  of  Such  a  Distribution. — Hilton  says :  "The 
object  of  such  a  distribution  of  nerves  to  the  muscular  and 
articular  structures  of  the  joints,  in  accurate  association,  is 
to  insure  mechanical  and  physiological  consent  between 
the  external  muscular,  or  moving  force,  and  the  vital  en- 
durance of  the  parts  moved,  namely,  of  the  joints,  thus 
securing  in  health  a  true  balance  of  force  and  friction  until 
deterioration  occurs." 

"Without  this  nervous  association  in  the  muscular 
and  articular  structures,  there  could  be  no  intimation  by 
the  internal  parts  of  their  exhausted  condition."  "Again, 
through  the  medium  of  the  muscular  and  cutaneous  nervous 
association  great  security  is  given  to  the  joint  itself  by 
those  muscles  being  made  aware  of  the  point  of  contact 
of  any  extraneous  force  or  violence.  Their  involuntary 
contraction  instinctively  makes  the  surrounding  structures 
tense  and  rigid,  and  thus  brings  about  an  improved  de- 
fence for  the  subjacent  structures." 

The  Uniformity  of  the  Law. — "This  articular,  muscu- 
lar and  cutaneous  distribution  of  the  nerves  is,  in  my 
opinion,  a  uniform  arrangement  in  every  joint  in  the  body. 
We  may  find  numerous  illustrations  of  the  same  method 
of  distribution  in  other  parts  of  the  body,  which  have  the 
same  definite  relations  to  each  other,  and  in  this  respect 
present  the  same  physiological  and  mechanical  arrange- 
ment observable  in  joints.  This  same  prin- 
ciple of  arrangement,  anatomically,  physiologically  and 
pathologically  considered,  is  to  be  observed  with  an  equal 
degree  of  accuracy  in  the  serous  and  in  the  mucous  mem- 
brane. Thus  considered,  it  presents  a  principle  which,  if 
it  has  any  application  in  practice,  must  be  one  certainly 
of  large  extent." 

Precision  of  Nervous  Distribution  to  Muscles. — "The 
great  precision  with  which  muscles  are  supplied  by  their 
nerves  is  worthy  of  remark;  and  is  such  that  if  we  have 


PRINCIPLES  OF  OSTEOPATHY  185 

before    us    a    contracted    muscle,    we    may   be    sure    of   the 
nerve  which  must  be  the  medium,  or  the  direct  cause  of  it." 

"In  studying  the  supply  of  nerves  to  muscles  over 
every  part  of  the  body,  we  find  a  great  degree  of  precision, 
which  marks  one  difference  between  their  distribution 
and  that  of  the  arteries." 

Indications  for  Use  of  Therapeutics. — "I  should  say  in 
aid  of  other  means,  employ  this  cutaneous  distribution  of 
nerves  as  a  road  or  means  toward  relieving  pain  and  irrita- 
tion in  the  joint.  You  thus  quiet  the  muscles,  prevent  ex- 
treme friction,  and  reduce  muscular  pressure  and  spasm. 
Therapeutics  may  certainly  reach  the  interior  of  this  joint 
and  its  muscles  through  the  medium  of  the  nerves  upon 
the  surface  of  the  skin,  and  so  induce  physiological  rest  to 
all  the  parts  concerned  in  moving  the  joint.  * 
The  advantage  to  be  derived  arises  in  this  way:  Sensibility 
of  the  filaments  supplying  the  skin  being  reduced,  that 
influence  is  propagated  through  the  sensitive  nerves  to  the 
interior  of  the  joint  and  to  the  muscles  moving  a  joint. 
This  diminution  of  sensibility  tends  to  give  quietude  or 
perfect  rest  to  the  interior  of  the  joint,  which  is  one  of  the 
most  important  elements  towards  the  successful  issue  of 
the  treatment  of  cases  of  this  kind." 

The  Use  of  Hilton's  Law  in  Physical  Diagnosis. — Hil- 
ton's law  is  applicable  in  physical  diagnosis.  The  osteo- 
path makes  constant  use  of  the  superficial  expressions  of 
nerve  activity.  After  having  learned  the  whole  course,  dis- 
tribution and  central  connections  of  the  nerve,  we  can 
judge  rightly  as  to  the  structures  involved  by  noting  the 
physiological  conditions  of  all  the  structures  innervated 
by  a  definite  nerve  trunk.  Hilton  applied  his  law  entirely 
from  the  physiological  side,  i.  e.,  he  observed  changes  in 
the  relations  of  joint  structures,  but  considered  the  de- 
formity as  due  to  excessive  physiological  action  of  the 
muscles  in  their  effort  to  secure  rest  for  the  joint  surfaces. 
This  is  largely  true,  but  he  did  not  question  how  the  pro- 
cess was  initiated.  The  osteopath  seeks  a  point  of  stimu- 


186  PRINCIPLES  OF  OSTEOPATHY 

his  to  the  nerves  controlling  a  joint  or  other  structure, 
believing  that  it  is  of  little  value  to  anaesthetize  nerve 
endings  and  give  rest  so  long  as  this  stimulus  is  allowed 
to  arouse  impulses  in  the  nerve  fibers. 

Comparison  of  Methods. — To  compare  methods  of  us- 
ing Hilton's  Law,  we  will  note  one  of  his  cases,  and  a  sim- 
ilar one  treated  osteopathically.  In  Chapter  VIII  of  "Rest 
and  Pain"  he  describes  a  case  of  inflammation  of  the  shoul- 
der joint,  and  mentions  that  the  joint  is  fixed  in  a  position 
of  rest  as  a  result  of  the  association  of  nerves  to  the  syno- 
vial  membrane,  the  muscles  of  the  joint  and  the  skin  over 
the  joint.  Anaesthesia  releases  the  fixedness  of  the  joint, 
because  the  muscles  do  not  contract  after  the  sensory  im- 
pulses are  deadened  by  the  anaesthetic.  He  says,  "Thera- 
peutics may  certainly  reach  the  interior  of  this  joint  and 
its  muscles  through  the  medium  of  the  nerves  upon  the 
surface  of  the  skin,  and  so  induce  physiological  rest  to  all 
parts  concerned  in  moving  the  joint.  I  mean  to  say  that 
these  nerves  upon  the  surface  of  the  skin  being  in  direct 
association  with  the  interior  of  the  joint  itself,  we  may 
reduce  the  muscular  spasm  as  well  as  the  sensibility  of 
the  interior  portion  of  the  joint,  by  applying  our  anaes- 
thetics with  accuracy  and  with  sufficient  intensity  upon 
the  exterior  of  the  deltoid  muscle,  over  the  distribution  of 
these  sensitive  filaments.  The  thought  will  occur  to  you 
at  once  that  there  is  nothing  very  remarkable  in  this  opin- 
ion, and  that  is  quite  true.  The  embrocations,  however, 
which  would  ordinarily  be  suggested  for  this  purpose,  are 
not  of  a  character  sufficiently  potent  to  alleviate  the  pain 
of  the  patient,  and  are,  I  believe,  seldom  employed  with  a 
definite  idea  in  the  mind  of  the  prescriber.  I  would  sug- 
gest that  we  should  employ  our  fomentations  strongly 
medicated  with  belladonna,  with  opium  or  with  hemlock, 
instead  of  using  mere  fomentation  of  hot  water.  Some  will 
say,  'Oh,  hot  water  is  quite  as  good;'  but  I  can  assure  you 
practically  that  it  is  not  so." 


PRINCIPLES  OF  OSTEOPATHY  187 

You  will  note  that  he  makes  use  of  the  cutaneous  re- 
flexes to  affect  the  interior  of  the  joint. 

A  recent  case,  corresponding  we  believe,  was  treated 
osteopathically  with  marked  success.  The  inflammation 
in  the  shoulder  joint  was  not  traumatic  in  origin  nor  did 
it  appear  to  be  rheumatic  in  character.  Hot  fomentations 
would  give  great  relief,  but  did  not  give  sufficient  rest  to 
the  joint  to  permit  of  a  cure.  The  fear  was  entertained 
that  longer  rest  of  the  articulation  would  result  in  adhe- 
sion and  loss  of  function  in  the  joint.  Since  the  circum- 
flex nerve  appeared  to  be  the  one  involved,  a  careful  ex- 
amination was  made  of  the  articulations  between  the  sixth 
and  seventh  cervical  vertebrae.  The  circumflex  nerve  is 
made  up  largely  of  fibers  from  the  sixth  cervical  nerve 
trunk.  Tension  and  tenderness,  together  with  slight  ro- 
tation of  the  sixth  cervical  were  noted  at  this  point.  The 
osteopath,  instead  of  working  over  the  area  of  distribution 
of  the  circumflex,  centered  his  work  upon  this  articulation 
to  bring  about  right  relations  between  the  sixth  and  sev- 
enth cervical  vertebrae.  Tension  and  irritation  were  re- 
moved. The  circumflex  nerve  ceased  to  manifest  any  un- 
due irritation.  The  osteopath  almost  invariably  works 
from  the  center  to  periphery  instead  of  the  reverse. 

Herpes  Zoster. — An  example  of  the  osteopath's  use,  or 
rather  recognition  of  Hilton's  law:  A  case  of  Herpes  Zoster 
located  along  the  course  of  the  left  fifth  intercostal  nerve 
was  given  a  grave  prognosis  by  a  homeopathic  physician. 
The  patient  visited  an  osteopath  immediately,  hoping  that 
some  relief  might  be  found  for  the  intolerable  pain.  The 
eruption  extended  from  the  spine  to  the  median  line  in 
front,  forming  a  band  about  one  inch  wide.  The  fifth  rib 
was  found  rotated  downward,  thus  lessening  the  fifth  inter- 
-  costal  space  and  pressing  on  the  nerve  at  some  point  in 
its  course.  This  rib  was  raised,  even  though  the  osteo- 
path's fingers  rested  directly  upon  the  eruption,  in  order 
to  force  the  rib  upward.  The  result  was  most  gratifying. 
Pain  decreased  almost  immediately,  and  there  was  a  rapid 


188 


PRINCIPLES  OF  OSTEOPATHY 


CIY 


SI 


FIG.  31.  Sensory  dermatomes  on  anterior  surface 
of  tne  body.  Drawn  by  John  Comstock  (after 
Head). 


PRINCIPLES  OF  OSTEOPATHY  189 

change  in  the  appearance  of  the  eruption,  the  •  firey  red 
giving  place  to  a  paler  color.  Those  papules  which  were 
just  forming  subsided,  and  those  which  had  formed  vesi- 
cles began  immediately  to  scab. 

The  patient  could  not  stand  erect,  lifting  the  arm 
caused  increase  of  pain,  likewise  inspiration  was  lessened 
because  it  caused  pain.  Hilton  would  say  that  these  move- 
ments were  curtailed  to  give  physiological  rest.  From 
the  osteopathic  standpoint,  they  are  reflexes  which  are  not 
reparative  in  character,  hence  must  be  eliminated.  Every 
movement  which  tended  to  separate  the  fifth  and  sixth  ribs 
caused  pain,  hence  the  patient  refrained  from  making  them. 
The  osteopath  separated  these  ribs,  even  though  the  pro- 
cess of  doing  so  caused  pain.  The  structural  defect  caus- 
ing the  irritation  was  removed.  In  view  of  the  fact  that 
Herpes  Zoster  is  associated  with  posterior  ganglionitis,  it 
may  be  that  the  subluxation  of  a  rib  is  a  secondary  lesion 
and  hence  only  a  secondary  cause  of  pain.  Clinical  exper- 
ience teaches  us  that  relief  is  obtained  in  these  cases  by 
separating  the  ribs  which  are  approximated  by  the  mus- 
cular tension. 

The  Distribution  of  an  Intercostal  Nerve. — The  distri- 
bution of  an  intercostal  nerve  is  to  the  pleura,  intercostal 
muscles  and  skin  over  these  muscles,  thus  corresponding 
to  the  distribution  of  nerve  trunks  to  the  synovial  mem- 
brane of  a  joint,  the  muscles  moving  the  joint  and  the  skin 
covering  the  joint. 

Some  of  the  Evil  Results  of  Rest. — If  we  give  rest  to 
all  structures  in  which  pain  is  located,  we  will  help  to  fill 
the  world  with  stiff  joints  and  serous  adhesions,  to  say 
nothing  of  the  far  reaching  after  affects  of  these  structural 
defects  upon  the  functional  activity  of  the  nervous  system. 
A  differential  diagnosis  is  required  in  all  cases  of  painful 
joints  in  order  to  determine  whether  it  is  wise  to  disturb 
the  physiologically  protective  reaction. 

Hilton's  law  may  be  called  an  anatomical  law;  there  do 
not  appear  to  be  any  exceptions  to  it,  especially  when  sup- 


190 


PRINCIPLES  OF  OSTEOPATHY 


CY; 


CHI 


S  1 


FIG.  32.  Sensory  dermatomes  on  posterior  surface 
of  the  body.  Drawn  by  John  Comstock  (after 
Head). 


PRINCIPLES  OF  OSTEOPATHY  191 

plemented  by  his  statement  that  "every  fascia  of  the  body 
has  a  muscle  attached  to  it,  and  every  fascia  throughout 
the  body  must  be  considered  as  the  insertion  of  a  muscle." 
This  carries  the  influence  of  motor  nerves  to  points  covered 
by  their  sensory  companions. 

Head's  Law. — Another  law,  or  in  this  case  a  compre- 
hensive statement,  has  been  made  by  Head  in  his  writings 
in  "Brain."  This  is  a  statement  of  physiological  transference 
of  pain  from  its  point  of  origin  to  a  point  of  conscious 
sensation.  This  physiological  law  is  stated  as  follows: 
"When  a  painful  stimulus  is  applied  to  a  part  of  low  sen- 
sibility in  close  central  connection  with  a  part  of  much 
higher  sensibility,  the  pain  produced  is  felt  in  the  part  of 
higher  sensibility  rather  than  in  the  part  of  lower  sensibil- 
ity to  which  the  stimulus  was  applied." 

Application  of  the  Law. — This  physiological  law  can 
be  applied  in  two  ways.  First,  we  may  consider  the  rela- 
tive sensibility  of  different  portions  of  a  nerve  trunk.  If  a 
stimulus  is  applied  to  a  nerve  trunk  at  some  point  in  its 
course  between  its  origin  and  distribution,  the  pain  caused 
by  the  stimulus  will  be  felt  in  the  area  of  distribution  of 
the  fibers  of  this  nerve  trunk  rather  than  at  the  point  where 
the  stimulus  is  applied.  The  skin,  mucous  or  serous  mem- 
brane and  muscle  in  which  sensory  nerves  end  are  areas  of 
high  sensibility  compared  with  the  trunk  of  the  nerve. 
The  brain  is  conscious  of  only  the  areas  of  distribution  of 
the  sensory  nerves,  hence  stimuli  applied  at  the  points  of 
low  sensibility  are  referred  to  the  areas  of  high  sensibility. 
Thus  all  lesions  causing  pressure  upon  nerve  trunks  cause 
pain,  contraction,  or  perversion  of  secretion  in  the  areas 
of  distribution.  The  patient  is  not  thoroughly  conscious 
of  any  location  but  the  area  of  distribution  which  is  an 
area  of  high  sensibility. 

The  cases  described  under  Hilton's  law  are  applicable 
here.  In  the  case  of  inflamed  shoulder  joint  the  patient 
was  not  conscious  of  the  irritation  at  the  spinal  column — 


192  PRINCIPLES  OF  OSTEOPATHY 

the  rotated  vertebra — this  was  an  area  of  low  sensibility 
in  the  course  of  the  nerve  trunk.  The  brain  attributed  all 
the  trouble  to  the  terminations  of  the  nerves  in  the  tissues 
of  the  joint.  All  of  the  reflexes  acted  accordingly. 

The  second  application  of  this  law  is  to  the  relative  in- 
tensity of  areas  of  high  sensibility.  The  areas  in  which 
sensory  nerves  end  are  all  areas  of  high  sensibility,  but 
some  are  higher  than  others.  We  note  in  practice  that 
sometimes  a  nerve  trunk  which  supplies  several  structures 
will  manifest  pain  in  a  portion  of  its  area  of  distribution 
which  is  not  the  part  in  which  the  irritation  is  located. 
For  example,  the  sensory  portion  of  the  obturator  nerve 
is  distributed  to  the  hip  joint  and  skin  on  the  inner  side 
of  the  knee.  The  skin  seems  to  be  an  area  of  higher  sen- 
sibility than  the  interior  of  the  hip  joint,  because  in  disease 
of  the  hij)  joint  the  patient  frequently  complains  of  pain 
in  the  cutaneous  area  rather  than  in  the  joint  where  the 
actual  disease  is  located. 

The  Viscera. — The  viscera  are  normally  non-sensitive, 
i.  e..  we  are  not  conscious  of  possessing  viscera.  The  pres- 
sure of  food  in  the  stomach  and  the  beat  of  the  heart  make 
no  impression  on  our  consciousness;  and  so  it  is  with  all 
parts  of  the  body  governed  by  sympathetic  nerves.  The 
viscera  are  areas  of  low  sensibility,  not  low  irritability, 
for  they  are  richly  supplied  with  sensory  nerves,  upon 
the  stimulation  of  which  active  functioning  depends.  The 
response  to  stimuli  of  sensory  nerves  in  viscera  is  rapid, 
but  normally  this  response  takes  place  entirely  outside  of 
our  consciousness,  the  impression  is  not  recognized  as  com- 
ing from  the  viscera,  but  from  a  remote  area  of  high  sen- 
sibility in  close  central  connection  with  the  less  sensitive 
area.  As  an  example,  pain  is  felt  in  the  right  shoulder,  as 
a  result  of  hyperaemia  of  the  liver.  The  pressure  upon 
sensory  nerves  in  the  liver  does  not  cause  pain  in  the  liver, 
but  refers  it  to  a  more  sensitive  area — the  skin  and  muscles 
of  the  right  shoulder. 


PRINCIPLES  OF  OSTEOPATHY  193 

Chronic  inflammation  of  the  stomach  may  cause  no 
consciousness  of  pain  in  that  organ,  but  may  cause  intense 
aching  in  the  mid-dorsal  region. 

Nerves  of  Conscious  Sensation. — Cerebro-spinal  nerves 
are  nerves  of  consciousness,  and  seem  to  have  the  duty  of 
registering  on  the  sensorium  of  our  brains  not  only  their 
own  impressions,  but  the  impressions  derived  from  that 
part  of  the  sympathetic  system  in  closest  central  connec- 
tion with  them. 

A  close  study  of  the  segmental  distribution  of  spinal 
nerves  and  their  connection  with  the  sympathetic  system 
by  the  rami-communicantes  will  make  Head's  law  of  prac- 
tical value  in  osteopathic  diagnosis  and  therapeutics. 


194  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  XI. 

OST  K( )  PAT  1 1 1 C  C  KXTKRS. 

Certain  points  on  the  surface  of  the  body  are  spoken 
of  as  "Centers."  This  word  has  become  a  part  of  the  osteo- 
path's technical  vocabulary.  It  does  not  convey  to  the 
mind  of  the  osteopath  the  same  meaning  which  attaches 
to  it  when  used  in  physiological  text-books. 

A  physiological  functional  center  in  the  central  nervous 
system  is  that  point  where  the  action  of  a  certain  viscus  or 
other  structure  is  governed. 

An  osteopathic  center  is  that  point  on  the  surface  of 
the  body  which  has  been  demonstrated  to  be  in  closest 
central  connection  with  a  physiological  center,  or  over  the 
course  of  a  governing  nerve  bundle. 

Tn  Chapter  1IT,  under  the  sub-heading  Segmentation, 
reference  is  made  to  the  division  of  the  central  nervous 
system  into  sections  which  may,  to  a  moderate  degree, 
functionate  independently.  Xo  portion  of  the  nervous  sys- 
tem ever  functionates  absolutely  independently.  The  ac- 
tion of  every  portion  affects  all  other  portions,  but  certain 
areas  in  the  brain  and  spinal  cord  seem  to  be  somewhat 
set  apart  to  govern  or  coordinate  the  physiological  activity 
of  certain  organs.  Physiology  has  demonstrated  a  large 
number  of  these  centers. 

"Physiology  shows  how  not  only  the  individual  gan- 
glia which  lie  in  the  intestines  function  with  relative  in- 
dependence, but  how  even  structures  like  the  spinal  gan- 
glia frequently  reckoned  in  with  the  central  system  still 
enjoy  relative  independence  from  it  functionally." 

"What  we  know  of  the  anatomical   structure  and  of 


PRINCIPLES  OF  OSTEOPATHY  195 

the  functions  of  the  central  nervous  system  of  vertebrates 
forces  us  more  and  more  to  the  conclusions  (1)  that  even 
individual  parts  of  the  central  system  are  themselves  in  a 
position  to  function  to  a  certain  extent  independently,  and 
(2)  that  even  the  brain  and  spinal  cord  of  vertebrates  are 
composed  of  a  series  of  centers.  Whether  the  one  or  the 
other  of  these  is  more  highly  developed,  whether  they 
are  in  connection  with  deeper  centers,  whether  they  have 
connections  among  themselves  and  with  higher  centers, 
determine  the  measure  of  the  higher  or  lower  development 
of  the  central  system.  We  will  find  later,  that  in  the  course 
of  the  development  of  a  class,  individual  centers  connected 
with  the  central  nervous  system  have  reached  a  high  de- 
velopment, while  others  have  arrived  at  a  certain  stage 
(or  reached  a  certain  type)  where  they  remain  stationary, 
and  throughout  all  subsequent  posterity  remain  everywhere 
alike. 

"One  can  conceive  that  in  its  essentials  every  nervous 
system  is  composed  of  afferent 'tracts  and  efferent  tracts, 
and  of  tracts  which  form  the  connection  of  the  elements 
among  themselves." 

Anatomy  and  Physiology  demonstrate  that  from  a 
certain  segment  of  the  spinal  cord  nerve  fibers  are  dis- 
tributed to  skin,  skeletal  muscles,  involuntary  muscles  and 
mucous  membrane  of  viscera,  and  to  the  muscular  coats 
of  the  arteries  supplying  all  these  structures. 

Physiology  and  Pathology  demonstrate  that  impres- 
sions made  upon  sensory  elements  in  skin,  mucous  mem- 
brane, muscle,  or  other  structures,  are  carried  to  a  center 
in  the  central  nervous  system.  These  impressions  are  co- 
ordinated in  this  center,  and  affect  the  physiological  action 
of  all  structures  innervated  from  the  same  center.  When 
we  speak  of  two  or  more  structures  being  in  close  central 
connection,  we  mean  that  they  are  innervated  from  the  same 
segment  of  the  central  nervous  system. 

Diagnosis. — In  diagnosis  these  segments  serve  the  pur- 
pose of  calling  the  osteopath's  attention  to  the  condition 


196 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   33.     Surface  marking  of   the   braehial   plexus. 


PRINCIPLES  OF  OSTEOPATHY  197 

of  several  correlated  structures.  For  example:  A  hyper- 
aesthesia  at  any  point  along  the  spinal  column  fixes  the 
attention  of  the  osteopath  upon  all  the  structures  of  the 
body  which  are  innervated  from  the  segment  of  the  central 
nervous  system  which  furnishes  nerves  for  this  over- 
sensitive area.  Examination  of  all  the  structures  thus 
supplied  will  probably  discover  the  point  chiefly  affected. 

In  order  to  give  the  student  a  clear  insight  into  the 
principles  underlying  osteopathic  diagnosis,  we  will  ex- 
amine the  osteopathic  centers  serially,  commencing  at  the 
atlas. 

First  Four  Cervical  Nerves. — We  will  first  divide  the 
spinal  column  into  sections  according  to  the  location  of 
certain  groups  of  nerves.  Remember  that  these  divisions 
are  made  with  reference  to  the  points  of  exit  of  the  spinal 
nerves  from  the  spinal  column. 

The  first  section  contains  the  first  four  cervical  nerves. 
The  first  cervical  nerve  leaves  the  spinal  canal  between  the 
occipital  bone  and  the  atlas.  A  study  of  its  distribution 
will  inform  us  what  structures  are  governed  by  it.  Its 
anterior  division  forms  a  part  of  the  cervical  plexus.  This 
division  communicates  with  the  sympathetic  nerves  on  the 
vertebral  artery,  the  pneumogastric,  the  hypoglossal,  and 
superior  cervical  sympathetic  ganglion.  It  innervates  the 
Rectus  Lateralis  and  Anterior  Recti. 

The  posterior  division  of  the  first  cervical  nerve  is 
called  the  suboccipital.  It  supplies  motor  fibers  to  the 
posterior  Recti  muscles  of  the  head,  the  Superior  and  In- 
ferior Oblique,  and  the  Complexus.  Sensory  fibers  from 
the  scalp  form  part  of  this  nerve. 

'  Example  of  Hilton's  Law. — With  this  outline  of  dis- 
tribution before  us,  we  can  note  some  of  the  results  of 
stimulation  of  this  nerve.  Since  the  anterior  division  sup- 
plies a  few  fibers  to  the  occipito-atlantal  articulation,  we 
have  an  example  of  Hilton's  law  of  distribution  of  a  nerve 
trunk.  The  synovial  membrane  of  the  occipito-atlantal 


198 


PRINCIPLES  OF  OSTEOPATHY 


articulation,  the  muscles  which  govern  movements  of  the 
joint,  and  the  skin  over  the  joint  are  all  innervated  by  this 
first  cervical  nerve. 

The   muscles   moving  the  occipito-atlantal   articulation 
act  according  to  impulses  reaching  the  point  of  origin  of 


FIG.    34.     Front 

brai'hial  plexus. 


\v    of    partial    paralysis    of    the 


the  first  cervical  nerve  over  sensory  fibers  ending  in  the 
skin  covering  the  back  of  the  head  and  this  articulation, 
also  from  those  ending  in  the  synovial  membrane  of  the 
joint.  These  impulses  are  coordinated  in  higher  centers 


PRINCIPLES  OF  OSTEOPATHY 


199 


of  the  brain  which  govern  equilibration.     The  muscles  of 
this  joint  act  also  according  to  our  will. 

The  Pneumogastric  Nerve. — Furthermore,  the  anterior 
division  of  this  nerve  communicates  with  the  pneumogas- 
tric,  hypoglossal,  and  the  superior  sympathetic  ganglion. 


FIG.   35.     Side  view  of  same  case  as  Fig.  34. 

The  pneumogastric  has  such  a  wide  distribution  that  we 
cannot  afford  to  follow  all  of  its  paths  of  influence  at  this 
time.  The  student  is  referred  to  any  extended  work  on 
anatomy  for  the  details.  The  muscles  and  mucous  mem- 
branes of  the  larynx  are  innervated  by  the  pneumogastric, 
hence  any  irritation  of  the  larynx  may  reflex  impulses  to 
the  center  of  origin  of  the  first  cervical  nerve  and  cause 
undue  contraction  of  the  muscles  innervated  by  it.  This 


200 


PR1XCIPLKS  OF  OSTEOPATHY 


muscular  contraction  can  result  in  changing  the  relation 
of  the  bones  forming  the  occipito-atlantal  articulation  until 
a  condition  exists  which  \ve  call  a  suhluxation  of  the  atlas. 
Having  followed  the  impulses  from  the  larynx  to  the 
center  of  coordination  and  out  again  to  the  muscles  of 


FIG.  36.     Rear  view  of  same  case  as  Fig.  34. 


the  occipito-atlantal  articulation  with  consequent  subluxa- 
tion,  we  may  profitably  note  the  fact  that  sudden  temper- 
ature changes  may  affect  the  skin  over  these  muscles, 
arousing  impulses  which  are  carried  to  the  center  of  co- 
ordination, thence  to  the  muscles,  causing  them  to  con- 
tract with  resulting  subluxation.  Some  of  the  reflex  im- 


PRINCIPLES  OF  OSTEOPATHY  201 


FIG.   37.     Topographical  outline  of  the  lungs. 


202  PRINCIPLES  OF  OSTEOPATHY 


FIG.  '38.     Posterior   surface   marking  of  the   lungs. 


PRINCIPLES  OF  OSTEOPATHY  203 

pulses  may  find  their  way  to  the  larynx  and  cause  con- 
gestion of  its  mucosa.  The  atlas  may  be  subluxated  by 
violence,  then  the  sensory  impulses  originate  in  the  syno- 
vial  membrane  of  the  joint  and  in  the  muscles  moving  the 
joint.  These  impulses  may  be  reflected  in  such  manner  as 
to  affect  the  larynx,  pharynx  and  other  structures  inner- 
vated by  the  pneumogastric.  The  reflex  influences  exist- 
ing between  the  first  cervical  nerves  and  the  pneumogas- 
tric are.  chiefly  confined  to  the  larynx  and  the  pharynx, 
because  spinal  nerves  usually  receive  sympathetic  reflexes 
from  the  segment  of  the  body  which  they  cover.  If  we 
should  follow  all  of  the  divisions  of  the  pneumogastrics, 
we  would  find  a  wonderful  diversity  of  distribution.  We 
do  not  expect  that  reflexes  from  the  heart,  lungs,  stomach, 
etc.,  are  going  to  be  subject  to  coordination  in  the  area 
of  origin  of  the  first  cervical  nerve,  just  because  there  is 
communication  between  the  pneumogastric  and  this  nerve. 
The  pharynx  and  larynx  are,  in  part,  structures  governed 
involuntarily,  and  hence  they  are  in  large  part  removed 
from  the  influence  of  nerves  carrying  voluntary  impulses, 
i.  e.,  spinal  nerves.  The  pneumogastric  is  essentially  sym- 
pathetic in  character.  The  tissues  of  the  larynx  and  phar- 
ynx are  practically  under  the  influence  of  the  first  cervi- 
cal nerve.  Your  attention  is  called  to  Hilton's  law  as  he 
has  stated  it  in  relation  to  mucous  and  serous  surfaces. 
"This  same  principle  of  arrangement,  anatomically,  physio- 
logically and  pathologically  considered,  is  to  be  observed, 
with  an  equal  degree  of  accuracy  in  the  serous  and  mu- 
cous membranes.  Thus  considered,  it  presents  a  prin- 
ciple which,  if  it  has  any  application  in  practice,  must  be 
one  certainly  of  large  extent." 

Since  the  spinal  accessory  forms  part  of  the  pneumo- 
gastric above  the  point  of  communication  between  that 
nerve  and  the  first  cervical,  we  can  perceive  the  reason 
for  the  great  influence  which  temperature  changes,  affect- 
ing the  skin  over  the  sterno-cleido-mastoid  and  trapezius 
muscles,  have  on  the  action  of  the  muscles  forming  the 


204 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    39.     The   lung  center. 


PRINCIPLES  OF  OSTEOPATHY  205 

suboccipital  triangles.  The  spinal  accessory  innervates  the 
sterno-cleido-mastoid  and  trapezius.  These  muscles  will 
contract  reflexly  when  the  sensory  nerves  in  the  skin  over 
them  are  affected  by  temperature  changes.  The  action  of 
these  muscles  affects  the  position  of  the  head  chiefly  by 
causing  movement  in  the  occipito-atlantal  articulation 
whose  accurate  adjustment  depends  on  the  muscles  inner- 
vated by  the  first  cervical  nerves. 

The  point  of  origin  of  the  first  two  cervical  nerves  is 
probably  a  bilateral  center.  In  order  to  secure  coordinated 
movements,  both  sides  of  this  bilateral  center  must  act 
reciprocally,  but  if  the  impulses  coming  into  the  center 
from  one  side  are  much  greater  in  number  and  intensity 
than  those  entering  on  the  opposite  side,  this  reciprocity 
of  action  may  be  interfered  with  and  subluxation  result. 

The  Hypoglossal  Nerve. — The  hypoglossal  nerve  is 
the  motor  nerve  to  the  muscles  of  the  tongue,  and  to  the 
muscles  moving  the  larynx  and  hyoid  bone.  It  commu- 
nicates with  the  first  cervical  nerve.  Movement  in  the 
occipito-atlantal  articulation  affects  the  relations  of  the 
points  of  origin  and  insertion  of  the  muscles  innervated 
by  the  hypoglossal ;  therefore,  impulses  passing  over  both 
nerves  are  coordinated  at  about  the  same  area. 

Superior  Cervical  Ganglion. — Probably  the  greatest 
cause  for  disturbance  along  the  course  of  the  first  cervi- 
cal nerve  is  the  communication  with  the  superior  cervical 
ganglion  and  the  sympathetic  plexus  on  the  vertebral  artery. 
This  communication  subjects  all  the  structures  innervated 
by  the  first  cervical  to  reflexes  initiated  in  various  areas  of 
the  head,  neck  and  brain. 

* 

The  superior  cervical  sympathetic  ganglion  has  a  vaso- 
' constrictor  influence  over  the  blood  vessels  of  the  head, 
neck  and  brain.  It  is  a  well  known  clinical  fact  that  ice 
applied  to  the  surface  of  the  neck  over  the  occipito-atlantal 
articulation  will  cause  constriction  of  the  blood  vessels  of 


206 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    40.     Cilio-spinal  and   heart   centers. 


PRINCIPLES  OF  OSTEOPATHY 


207 


FIG.   41.     Surface  outline  of  the  heart. 


208 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    42      Surface   outline   of   the   stomach. 


PRINCIPLES  OF  OSTEOPATHY  209 

the  brain.  This  constriction  is  a  reflex  effect  due  to  the 
communication  of  the  first  cervical  nerve  with  the  superior 
cervical  sympathetic  ganglion. 

Suboccipital  Triangles. — When  the  first  cervical  nerve 
is  sensitive  to  moderate  pressure  over  the  suboccipital  tri- 
angles, we  may  be  sure  that  it  is  evidence  of  disturbance 
of  circulation  in  some  part  of  the  head,  neck  or  face.  We 
look  for  this  disturbance  in  the  structures  which  are 
subjected  to  the  greatest  amount  of  work,  i.  e.,  the  eye, 
pharynx  or  larynx.  The  brain  last,  because  it  is  not  easily 
fatigued.  Sensitiveness  is  nearly  always  associated  with 
a  subluxated  atlas,  i.  e.,  one  is  indicative  of  the  other. 

Whether  the  subluxation  is  primary  or  secondary,  it 
is  a  source  of  irritation  and  must  be  reduced;  therefore, 
in  practice,  our  treatment  is  applied  primarily  to  this 
changed  structure.  The  results  of  practice  prove  this  to 
be  the  best  method. 

Patients  rarely  complain  of  sharp  neuralgic  pain  in 
the  area  of  the  suboccipital  triangles.  A  dull  ache  or  ten- 
sion is  the  usual  subjective  symptom. 

Wre  have  described  the  characteristics  of  this  center 
with  considerable  detail  in  order  that  the  student  may 
understand  how  thoroughly  an  accurate  knowledge  of 
anatomy  and  physiology  enters  into  the  work  of  the  osteo- 
path. Every  center  must  be  understood  in  this  same  man- 
ner. We  do  not  deem  it  necessary  to  go  into  such  detail 
in  describing  all  of  the  remaining  centers  in  order  that 
the  student  can  understand  their  significance. 

In  order  to  make  the  characteristics  of  the  first  cervical 
nerve  stand  out  prominently,  we  have  described  it  as 
though  it  were  individual  in  its  action  and  reaction.  This 
is  not  strictly  true.  Analysis  compels  us  to  note  ill-defined 
separations  in  the  nervous  system.  In  order  to  get  a  right 
conception,  we  must  view  the  first  cervical  nerve  as  only 
one  of  a  group  of  four  cervical  nerves  which  act  in  harmony. 


210  PRINCIPLES  OF  OSTEOPATHY 


FIG.    43.     Tiie    stomach    center. 


PRINCIPLES  OF  OSTEOPATHY  211 

Cervical  Plexus. — The  first  four  cervical  nerves  are  in- 
terwoven to  form  a  plexus.  Each  distributive  branch 
from  this  plexus  probably  contains  some  communicating 
fibers  from  the  four  primary  nerve  trunks.  Viewing  the 
plexus  as  a  whole,  we  find  that  its  branches  are  distributed 
according  to  Hilton's  law.  They  innervate  the  skin  of 
the  neck  as  low  as  the  fifth  cervical  spine  posteriorly,  then 
obliquely  forward  as  low  as  the  sterno-clavicular  articula- 
tion anteriorly,  and  the  acromio-clavicular  articulation 
laterally.  The  skin  of  the  posterior  surface  of  the  cranium 
and  the  ear  receives  sensory  fibers  from  this  plexus.  These 
are  the  gross  points  to  be  remembered  concerning  cutan- 
eous sensory  distribution  from  this  plexus.  The  muscles 
under  this  cutaneous  area  all  receive  motor  fibers  from  the 
first  four  cervical  nerves. 

Anatomists  divide  the  cervical  nerves  into  anterior 
and  posterior  'divisions,  then  desc/ribe  these  separately. 
This  is  an  artificial  division  which  does  not  serve  any  use- 
ful purpose  for  us.  It  multiplies  detail  without  giving 
an  adequate  conception  of  the  real  character  of  the  whole 
nerve.  When  you  study  the  ultimate  distribution  of  the 
anterior  division  of  a  nerve  forming  the  cervical  plexus, 
do  not  fail  to  remember  that  the  ultimate  distribution  of 
the  posterior  division  is  a  part  of  the  same  nerve.  If  the 
anterior  division  communicates  with  a  sympathetic  gan- 
glion, the  posterior  division  receives  impulses  from  and 
sends  impulses  to  this  ganglion.  If  the  anterior  division 
communicates  with  the  vagus  and  hypoglossal  nerves,  the 
posterior  division  is  a  party  to  this  communication,  and 
in  all  ways  benefits  or  suffers  by  it  according  to  the  num- 
ber and  intensity  of  the  stimuli  applied  at  any  point  along 
the  course  of  either  nerve. 

This  upper  portion  of  the  neck  is  the  most  flexible 
part  of  the  whole  spinal  column.  It  is  subjected  to  more 
changes  of  temperature  and  more  strains  or  twists  than 
other  portions  of  the  spine.  The  constant  effort  to  save 
the  head  from  injury  puts  a  severe  tax  upon  the  activity 


212  PRINCIPLES  OF  OSTEOPATHY 


FIG.   44.     The  splanchnic  area. 


PRINCIPLES  OF  OSTEOPATHY  213 

of  the  muscles  moving  this  portion  of  the  spinal  column. 
Subluxations  of  the  atlas  and  third  cervical  are  quite  fre- 
quent. Muscular  lesions,  contractions,  are  found  here  in 
connection  with  functional  disorders  of  many  kinds  lo- 
cated in  the  brain,  eyes,  ears,  nose,  mouth  or  throat.  Al- 
most invariably  a  relaxation  of  these  contractions  will  be 
a  necessary  step  in  relieving  disorders  in  the  areas  named. 

Intensity  of  Reflexes. — Individuals  differ  greatly  in 
the  intensity  of  their  reflexes.  Anatomically  considered, 
the  connections  between  the  sympathetic  and  cerebro- 
spinal  systems  are  alike  in  all  individuals,  but  physiolog- 
ically considered,  there  is  a  vast  difference  in  the  degree 
of  independent  functioning  of  these  systems.  Patients 
will  be  found  whose  symptoms  and  lesions  do  not  show 
any  marked  tendency  toward  reflexing  impulses  from  one 
system  to  the  other.  The  sympathetic  nerve  cells  may 
be  so  vigorous  that  severe  lesions  affecting  cerebro-spinal 
nerves  do  not  in  the  least  disturb  the  rhythm  of  the  sympa- 
thetic system.  Likewise,  severe  functional  disturbances 
may  exist  in  the  area  of  the  sympathetic  control  without 
causing  very  definite  conscious  sensations. 

The  Spinal  Accessory. — The  sterno-cleido-mastoid  and 
trapezius  muscles  are  innervated  by  the  spinal  accessory. 
This  nerve  arises  from  the  spinal  cord  as  low  as  the  sixth 
cervical,  therefore  its  impulses  are  coordinated  with  the 
cervical  plexus  in  the  area  of  its  normal  control. 

The  Phrenic  Nerve — Hiccough. — The  phrenic  nerve  is 
the  motor  nerve  from  the  cervical  plexus.  It  innervates 
the  diaphragm.  It  is  formed  by  branches  of  the  third, 
fourth  and  fifth  cervical  nerves.  The  position  of  this  nerve 
in  its  course  along  the  anterior  surface  of  the  scalenus 
anticus,  makes  it  convenient  to  apply  direct  inhibitory 
pressure  over  the  nerve  trunk.  This  pressure  has  a  re- 
straining influence  over  the  impulses  traveling  to  the  dia- 
phragm ;  therefore,  we  inhibit  to  stop  hiccough.  We  have 
treated  cases  in  which  inhibition  was  of  no  avail.  In  such 
cases  a  strong  movement  of  the  head  and  first  three  cervi- 


214 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    45.     Posterior  surface  outline   of  the  liver  and   spleen   with  their 
centers  indicated. 


PRINCIPLES  OF  OSTEOPATHY  215 

cal  vertebrae,  as  a  solid  lever,  to  secure  rotation  and  re- 
laxation between  the  third  and  fourth  cervical  vertebrae 
may  give  good  results.  Since  hiccough  is  a  reflex  due  to 
stimulation  of  sensory  nerves,  especially  the  pneumogas- 
tric,  it  should  not  be  expected  that  inhibition  of  the  motor 
nerve,  phrenic,  would  entirely  stop  hiccoughs  while  the 
sensory  stimulation  is  continued.  Clinically,  we  find  that 
inhibition  of  the  phrenic  nerve  is  sufficient  to  stop  the 
ordinary  case  of  hiccoughs.  Therefore,  we  call  the  area 
over  the  course  of  the  phrenic  nerve,  as  it  crosses  the  sca- 
lenus  anticus  muscle  opposite  the  fifth  cervical  transverse 
process,  the  "center  for  hiccoughs."  See  Fig.  266. 

The  Trapezius  and  Splenius  Capitis  et  Colli  Muscles. 
— The  cervical  plexus  communicates  with  the  brachial 
plexus;  therefore  we  expect  that  those  large  muscles,  such 
as  the  trapezius  and  splenius,  which  are  innervated  by 
nerves  from  segments  of  the  spinal  cord,  at  various  levels, 
will  transmit  by  their  action  the  influence  reflexed  to  them 
at  the  point  of  their  serial  innervation.  The  spinal  acces- 
sory innervates  a  large  part  of  the  cervical  fibers  of  the 
trapezius.  The  third  and  fourth  cervical-  nerves  send 
branches  to  this  muscle.  Therefore  any  disturbance  along 
the  course  of  these  nerves,  or  along  the  course  of  other 
nerves  in  close  central  connection  with  them  which  may 
cause  abnormal  contraction  of  the  trapezius,  will  influence, 
more  or  less,  all  the  points  of  attachment  of  that  muscle. 
The  trapezius  is  seldom  abnormally  contracted.  Any  les- 
sening in  the  normal  range  of  its  action  is  quickly  noted 
by  the  patient.  The  contractured  condition  is  easily  re- 
moved by  a  willed  action.  We  use  the  trapezius  muscle 
as  a  means  of  transmitting  power  to  various  portions  of 
the  spinal  column,  i.  e.,  in  our  efforts  to  move  one  or  more 
vertebrae. 

Vaso-motion,  Head,  Face  and  Neck. — The  superior 
cervical  eansflion  communicates  with  the  first  four  cervical 

o         o 

nerves,  therefore  the  area  over  the  spines  of  the  first  four 


216 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   46.     Anterior  surface  outline  of  the  liver  and  large  intestine. 


PRINCIPLES  OF  OSTEOPATHY  217 

cervical  vertebrae  is  called  a  vaso-motor  center  for  the 
head,  face  and  neck. 

Affections  of  the  Cervical  Nerves. — These  upper  cer- 
vical nerves  are  seldom  paralyzed.  Paralysis  in  this  region 
would  stop  the  action  of  the  diaphragm.  Neuralgia  may 
affect  the  nerves  of  this  group.  Spasmodic  contraction  of 
the  muscles  innervated  from  this  area  is  not  uncommon. 

Brachial  Plexus. — The  four  lower  cervical  nerves  arise 
from  the  cervical  enlargement  of  the  cord  and  form  the 
brachial  plexus  with  their  anterior  divisions,  while  their 
posterior  divisions  supply  motor  fibers  to  muscles  on  the 
sides  and  back  of  the  neck,  and  sensory  fibers  to  the  skin 
over  these  muscles.  The  anterior  division  of  the  first  dor- 
sal nerve  forms  a  part  of  the  brachial  plexus. 

Fig.  33  illustrates  the  superficial  area  in  which  the 
reflexes  from  the  skin  and  muscles  of  the  arm  are  mani- 
fested. Subluxations  or  muscular  contractions,  in  this 
area  may  affect  one  or  more  branches  of  this  plexus. 

Affections  of  the  Brachial  Nerves. — Neuralgia,  paraly- 
sis or  spasm  may  affect  the  area  innervated  by  this  group. 
Cervico-brachial  neuralgia  is  quite  common.  A  lesion  will 
usually  be  found  affecting  the  painful  nerve  at  its  point  of 
exit  from  the  spinal  column.  Paralysis  rarely  affects  this 
plexus  independently  of  the  nerves  leaving  the  cord  at  a 
lower  level.  Spasm  is  represented  by  such  a  condition  as 
writer's  cramp. 

Lesions  causing  cramp  or  neuralgia  may  be  located 
at  the  point  of  exit  of  the  nerve  from  the  spinal  column, 
but  the  clot  or  other  pressure  causing  paralysis  is  usually 
located  in  the  brain.  Paralysis  of  the  brachial  plexus  is  a 
part  of  a  hemiplegia ;  it  does  not  occur  independently  of 
the  more  general  condition.  Paralysis  of  certain  groups  of 
muscles  of  the  arm,  forearm  or  hand  can  usually  be  traced 
to  the  direct  injury  of  individual  nerve  trunks  in  the  arm. 

Hemiparesis  Below  Fifth  Cervical  Vertebra. — Figures 
34,  35  and  36  illustrate  the  results  of  pressure  upon  the 
spinal  cord  at  a  point  between  the  fourth  and  fifth  cervical 


218 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  47.-  Center  for  large  intestine.  The  arrow  marks  point  of 
close  connection  of  cerebro-spinal  nerves  with  the  hypogastric 
plexus. 


PRINCIPLES  OF  OSTEOPATHY  219 

vertebrae.  The  child  was  not  very  strong  at  the  time  of 
the  injury.  A  slight  fall,  while  playing,  subluxated  the 
fifth  cervical.  No  notice  was  taken  of  this  slight  fall.  The 
next  day,  while  bathing  the  child,  the  mother  noted  a  pe- 
culiarity in  the  position  of  the  shoulder.  The  arm  could 
not  be  raised  above  the  head.  The  author  examined  this 
case  the  day  the  mother  discovered  the  change  in  the 
shoulder.  At  first  glance  from  the  side,  it  appeared  to  be 
a  sub-spinous  dislocation  of  the  humerus,  but  palpation 
disproved  this.  Careful  examination  showed  a  hemipare- 
sis  of  the  whole  left  side  below  the  fourth  cervical  nerve. 
None  of  the  normal  movements  were  lost,  but  it  required 
the  utmost  effort  of  the  patient  to  make  them.  Now  and 
then  the  left  toe  would  strike  the  floor  too  soon  and  slight- 
ly trip  her.  Palpation  of  the  fifth  cervical  vertebra 
showed  a  lateral  subluxation.  The  slightest  pressure  at 
this  point  caused  the  patient  to  cry  out  wifli  pain. 

After  our  examination  (these  photographs  were  taken 
at  that  time)  the  child  was  taken  to  a  surgeon,  who  pre- 
scribed a  surgical  operation  to  stitch  the  latissimus  dorsi 
to  its  proper  position  on  the  lower  angle  of  the  scapula. 
He  did  not  recognize  the  paretic  condition  of  the  whole 
left  side.  After  a  short  time,  the  child  was  brought  to  us 
for  treatment.  Our  sole  effort  was  to  reduce  the  subluxa- 
tion of  the  fifth  cervical  vertebra.  The  tenderness  was  so 
great  that  this  was  manifestly  out  of  the  range  of  possi- 
bilities with  a  delicate  child.  After  two  weeks  of  relaxing 
around  this  articulation  a  direct  movement  was  made  to 
reduce  the  subluxation.  The  alignment  was  perfected, 
but  no  immediate  good  results  were  noted.  A  continued 
increase  in  nerve  power  has  gradually,  in  large  measure, 
overcome  the  deformity. 

Subluxation  of  the  Scapula. — The  deformity  is  the  ef- 
fect of  uneven  contraction  of  muscles.  The  latissimus 
dorsi,  rhomboids  and  serratus  magnus  are  weakened  while 
the  levator  anguli  scapuli  and  cervical  fibers  of  the  trape- 
zius  are  contracting  with  their  customary  power.  The 


220  PRINCIPLES  OF  OSTEOPATHY 

muscles  innervated  by  nerves  from  above  the  lesion  are 
acting  normally,  but  their  action  is  not  resisted.  This 
results  in  subluxation  of  the  scapula. 

The  Nerve  of  Wrisberg. — A  division  of  the  first  dorsal 
nerve  forms  the  first  intercostal  nerve.  The  inner  side 
and  back  of  the  arm  receive  cutaneous  branches  from  the 
first  dorsal  nerve.  There  is  communication  between  the 
cutaneous  nerves  to  this  area  and  the  second  intercostal 
nerve  by  means  of  the  nerve  of  \Yrisberg,  hence  pain  is 
frequently  felt  along  the  inner  surface  of  the  arm  in  cases 
of  heart  trouble,  intercostal  neuralgia  in  the  second  space, 
or  pleurisy. 

The  Interscapular  Region. — The  division  of  the  spinal 
column  between  the  first  and  seventh  dorsal  vertebrae  is 
commonly  called  the  interscapular  region.  It  is  an  ex- 
ceedingly important  one.  It  is  sometimes  called  the  pul- 
monary region,  because  it  is  the  area  from  which  the  lungs 
derive  many  nerves.  Sensory  impulses  from  the  lungs  are 
coordinated  in  this  area. 

Figure  37  illustrates  the  anterior  surface  outline  of 
the  lungs,  while  Fig.  38  shows  the  outline  on  the  posterior 
surface  of  the  thorax.  These  markings  were  made  on  the 
surface  according  to  physical  methods  of  diagnosis.  They 
represent  the  average  position  of  the  lungs  in  a  healthy 
man. 

Lung  Center. — Figure  39  illustrates  the  lung  center 
within  which  sensory  impulses  from  the  lungs  are  co- 
ordinated. A  large  proportion  of  cases  of  bronchitis, 
pulmonitis  or  pleuritis  of  either  the  simple  or  bacterial 
types,  are  accompanied  by  great  sensitiveness  in  this  area. 
This  sensitiveness  is  in  the  contracted  muscles,  or, 
when  the  shape  of  the  thorax  is  greatly  changed,  at  the 
angles  of  the  ribs.  Subluxations  of  ribs  or  vertebrae  in 
this  area  are  sometimes  found  in  connection  with  the  in- 
flammations above  named.  Whether  they  are  the  cause 
or  the  effect  of  the  inflammation  can  only  be  told  by  the 


PRINCIPLES  OF  OSTEOPATHY  221 

history.  Because  the  two  conditions,  that  is,  inflamma- 
tion in  the  thoracic  vfscera  and  osseous  subluxation,  exist 
at  the  same  time  is  no  reason  for  saying  that  the  subluxa- 
tion is  necessarily  the  cause  of  the  inflammation.  That  is 
a  mere  dogmatic  assertion  which  lacks  scientific  proof. 


FIG.   48.     Center  for  chills. 


222  PRINCIPLES  OF  OSTEOPATHY 

The  condition  might  be  just  the  opposite.  We  do  not  de- 
sire to  confuse  our  readers  in  the  least,  but  it  should  be 
remembered  that  before  making  a  dogmatic  statement 
such  as  "disease  is  the  result  of  anatomical  abnormalities 
followed  by  physiological  discord,"  we  should  be  certain 


FIG.   49.     Center  for  the  gall  bladder. 


PRINCIPLES  OF  OSTEOPATHY  223 

that  our  statement  is  not  based  on  a  series  of  selected  co- 
incidences. The  old  saw:  "It's  a  poor  rule  that  does  not 
work  both  ways,"  is  decidedly  applicable  to  nerve  reflexes. 

Cilio-Spinal  Center.  —  Tenderness  in  this  area  is  not 
necessarily  indicative  of  physiological  disturbance  in  any 
thoracic  viscus.  Fig.  40  indicates  two  centers.  The  one 
between  the  second  and  third  dorsal  is  called  the  cilio- 
spinal  center.  Detail  concerning  this  center  will  be  found 
in  the  chapter  on  the  Sympathetic  Nervous  System. 

The  fact  that  the  vaso-constrictor  fibers  to  the  cervical 
sympathetic  ganglia  leave  the  spinal  cord  below  the  second 
dorsal  vertebra  shows  that  some  reflexes  from  the  head, 
face  and  neck  may  be  coordinated  in  the  interscapular 
region. 

Heart  Center. — The  point  between  the  fourth  and  fifth 
dorsal  spines  is  noted  as  a  heart  center.  We  have  not  found 
any  text-book  authority  for  this  statement.  Clinical  ex- 
perience leads  the  author  to  locate  a  heart  center  at  this 
point.  What  the  absolute  influence  of  this  center  is  we  do 
not  know.  From  observation  of  cases  of  angina  pectoris 
it  appears  to  be  a  sensory  and  vaso-motor  center  for  the 
heart.  Stimulation  of  this  center  by  a  quick  percussion 
stroke  of  the  fingers  will  bring  on  an  immediate  attack  of 
pain  in  the  .heart,  blueness  of  lips  and  finger  tips.  Heavy 
digital  pressure  at  this  point  relieves  the  pain.  Steady  ex- 
tension of  the  whole  spinal  column  does  not  stimulate  such 
cases,  but  as  the  pull  is  reduced  and  the  vertebrae  are  drawn 
closer  together,  this  point  is  frequently  stimulated.  In  or- 
der to  avoid  an  attack  after  extension,  it  is  necessary  to 
lessen  the  force  of  the  pull  very  gradually  and  evenly. 

Fig.  41  illustrates  the  surface  markings  of  the  heart. 
This  organ  has  three  centers.  (1)  The  pneumogastric  nerve 
.exerts  an  inhibitory  influence.  This  nerve  can  be  stimu- 
lated in  the  neck.  See  Fig.  267.  (2)  The  accelerator  cen- 
ter includes  second,  third  and  fourth  dorsal.  See  Chapter 
VI  on  the  Sympathetic  Nervous  System.  (3)  Vaso-motor 
and  sensory  center  is  found  between  fourth  and  fifth  dorsal. 


224 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  50.  Center  for  the  ovaries.  Reflexes  from  the  ovaries  may 
follow  the  ovarian  plexus  to  the  aortic  and  reach  the  cerebro- 
spinal'  system  at  this  point.  This  is  true  for  the  testes  also. 


PRINCIPLES  OF  OSTEOPATHY  225 

Stomach  Center. — The  surface  outline  of  the  stomach 
is  given  in  Fig.  42,  while  its  reflex  surface  center  on  the 
back  is  indicated  in  Fig.  43.  This  center  lies  wholly 
•within  the  pulmonary  area,  therefore  it  will  be  readily 
noted  that  there  is  opportunity  for  much  careful  reasoning 
in  order  to  determine  whether  a  lesion  between  the  first  and 
seventh  dorsal  vertebrae  is  connected  with  disturbance  of 
the  lungs,  pleura,  heart,  eyes  or  stomach.  Clinically,  we 
distinguish  somewhat  as  follows :  A  lesion  covering  a 
large  part  of  this  area  is  probably  pulmonary.  A  lesion  in 
the  lower  half  and  extending  below  the  seventh  spine  is 
probably  gastric  in  character.  When  the  lesion  is  at  the 
third  or  fourth  and  decidedly  limited,  i.  e.,  the  tenderness 
is  sharply  circumscribed  in  this  area,  it  is  impossible  to 
tell,  except  by  further  examination  of  the  heart,  bronchi 
and  eyes,  to  which  it  belongs.  The  experienced  diagnos- 
tician can  frequently  estimate  the  probable  relation  of  a 
lesion  by  his  power  of  reading  the  signs  of  disease  as  evi- 
denced by  expression,  posture  and  general  indications. 

The  splanchnic  area  is  a  large  and  important  one.  It  is 
indicated  in  Fig.  44.  We  have  noted  in  this  photograph 
the  upper  connections  of  the  splanchnic  nerves  in  the  pul- 
monary area.  This  explains  the  high  position  occupied  by 
some  reflexes  from  the  first  part  of  the  gastro-intestinal 
tract.  Wonderful  influences  can  be  secured  in  this  area, 
over  circulation  in  the  abdominal  viscera. 

Liver  and  Spleen  Center. — The  liver  and  spleen  re- 
ceive their  sensory  and  vaso-motor  innervation  from  the 
eighth,  ninth  and  tenth  dorsal  nerves.  The  surface  mark- 
ings and  center  are  indicated  by  ,  Fig.  45.  The  liver  fre- 
quently reflexes  its  disturbed  sensory  influences  to  the 
right  shoulder.  We  have  noted  cases  of  gastric  disorder 
or  enlarged  spleen  which  reflexed  sensory  impressions  to 
the  left  shoulder. 

Large  Intestine. — Fig.  46  pictures  the  surface  mark- 
ings of  the  liver  and  large  intestine.  These  average  nor- 
mal outlines  should  be  thoroughly  remembered  and  used 


226 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    51.     Posterior  surface  outline  of   the  kidneys. 


227 

when  making  a  physical   examination.     The   spinal  center 
of  the  large  intestine  is  indicated  by  Fig.  47. 

Small  Intestine. — The  first  portion  of  the  small  intes- 
tine, duodenum,  is  innervated  from  about  the  same  area 
as  the  liver.  Fig.  45.  It  must  be  borne  in  mind  that  the 
splanchnic  area  is  a  large  one  and  comprehends  these 
smaller  centers.  Many  of  these  points  indicated  as  cen- 
ters are  the  areas  which  clinical  experience  has  noted  in 
connection  with  visceral  disturbance.  The  repeated  ex- 
perience of  many  cases  gives  them  value  for  diagnostic 
and  therapeutic  purposes. 

Center  for  Chills. — Within  the  area  indicated  by  Fig. 
48,  there  is  a  center  usually  described  as  the  eighth  dor- 
sal, which  has  received  the  name  of  "the  center  for  chills." 
Our  first  observation  of  the  action  of  this  center  was  in 
connection  with  a  case  of  malarial  fever.  Heavy  inhibi- 
tion of  this  area  lessened  the  severity  of  the  chill.  We 
have  observed  the  effects  of  inhibition  of  this  center  in 
many  cases  of  chill  due  to  nervousness,  onset  of  La 
Grippe  or  other  infectious  diseases,  and  to  abscess  forma- 
tion. In  all  cases  the  treatment  was  distinctly  helpful 
to  the  patient. 

The  Language  of  Pain. — Homeopathic  medical  prac- 
tice notes  variations  in  the  character  of  pain,  and  uses 
these  characteristics  as  indications  for  the  administra- 
tion of  special  drugs,  as  though  a  nerve  fiber  expressed  a 
language  of  pain.  To  the  osteopathic  physician,  it  is  suf- 
ficient that  a  nerve  express  a  disturbance  at  some  point 
of  its  course.  This  cry  of  the  nerves  calls  for  just  one 
thing,  remove  the  cause.  Search  is  made  for  this  cause 
along  its  entire  course,  and  the  course  of  its  connections. 

Osteopathic  View  of  Pathology. — Another  particular 
in  which  the  osteopathic  pathology  differs  from  other 
schools  of  medicine  is  in  the  way  we  view  varying  condi- 
tions of  a  viscus.  To  the  medical  practitioner,  simple 


228 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  52.     End  of  the  spinal  cord.     Physiological  center  for  parturition, 
defecation  and  micturition. 


PRINCIPLES  OF  OSTEOPATHY  229 

gastritis  is  a  vastly  different  condition  from  gastric  ulcer. 
To  the  mind  of  the  osteopath,  these  conditions  differ  in 
degree,  not  in  kind.  The  same  organ,  the  same  blood 
supply,  the  same  nerves  are  involved  in  both  conditions, 
therefore  we  treat  these  structures.  Our  dietetic  treat- 
ment takes  account  of  the  differing  activity  of  the 
stomach,  but  our  manipulative  treatment  does  not. 

We  apply  this  same  method  to  all  organs.  Our  man- 
ipulative therapeutics  are  based  on  structure  more  than 
on  function. 

Center  for  Gall  Bladder. — The  gall  bladder  lies  under 
the  anterior  extremity  of  the  tenth  rib.  In  cases  of  gall 
stone  the  area  of  the  tenth  dorsal  spine  has  been  found 
to  be  sensitive.  All  of  the  structural  and  functional 
changes  connected  with  gall  stones  have  seemed  to  center 
at  this  area,  and  along  the  tenth  rib.  Fig.  49  indicates 
the  center  for  the  gall  bladder  at  the  spine. 

Intestines. — The  small  intestines  are  governed  from 
the  lower  part  of  the  splanchnic  area,  ninth,  tenth,  elev- 
enth and  twelfth  dorsal.  The  large  intestine  is  controlled 
by  nerves  from  the  lumbar  region.  There  is  a  segmental 
distribution  of  these  nerves  to  the  large  and  small  intes- 
tines. This  segmental  arrangement  is  exemplified  in 
cases  of  diarrhoea.  If  the  large  intestine  is  the  part  af- 
fected, our  manipulation  is  devoted  to  the  lumbar  region. 
Reflexes  from  the  bowels  may  be  found  at  any  point  be- 
tween the  ninth  dorsal  and  the  fourth  sacral. 

fn  five  consecutive  cases  of  appendicitis,  the  reflex 
was  located  at  the  third  and  fourth  lumbar  spines.  Fig., 
47  indicates  the  area  concerned  in  reflexes  from  the  large 
intestine. 

Uterus. — The  position  of  the  arrow  in  Fig.  47  indi- 
cates the  point  of  apparently  close  connection  between 
the  hypogastric  plexus  and  the  cerebro-spinal  system. 
This  point  is  frequently  the  seat  of  great  tenderness  which 
is  entirely  reflex  in  character.  All  of  the  pelvic  viscera 


230 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   53.     Areas  of  the  lumbar  and  sacral    plexuses. 


PRINCIPLES  OF  OSTEOPATHY  231 

at  times  send  reflexes  here.  The  uterus  more  than  any 
other  pelvic  organ  manifests  its  disturbed  condition  by 
tenderness  at  this  point. 

The  uterus  is  such  a  changeable  organ  that  it  is  the 
chief  disturber  of  sympathetic  rhythm  in  a  woman's  body. 
A  change  in  its  position  causes  a  change  in  its  blood  sup- 
ply, followed  by  congestion  of  its  mucosa.  This  con- 
gested condition  sets  up  a  series  of  impulses  in  the  sympa- 
thetic system  which  may  never  reach  the  cerebro-spinal 
system.  They  spend  their  force  on  the  various  organs 
governed  by  the  sympathetic  nervous  system,  the  heart, 
stomach,  bowels,  etc.  Fig.  55  illustrates  the  difference 
in  the  heart's  rhythm  in  the  same  patient.  The  first 
sphygmogram  was  taken  while  the  patient  had  considera- 
ble difficulty  in  moving  about  on  account  of  the  heart's 
very  irregular  action.  The  uterus  is  prolapsed.  Patient 
has  worn  a  stem  pessary  for  years.  When  the  patient 
takes  the  genu-pectoral  position  and  inhales  strongly, 
while  pulling  upward  on-  the  abdominal  muscles  there  is 
great  relief,  but  when  the  heart  becomes  as  irregular  as 
this  sphygmogram  indicates,  she  is  afraid  to  take  -this  po- 
sition. After  twenty-four  to  seventy-two  hours  of  ir- 
regular action,  the  heart  regains  its  rhythm.  The  position 
of  the  uterus  becomes  changed  by  the  moving  of  the  pa- 
tient in  bed.  The  perineum  is  badly  torn  and  the  uterine 
ligaments  are  greatly  lengthened,  hence  the  organ  cannot 
be  kept  in  one  position.  She  has  refused  operation. 

Many  different  points  are  named  as  centers  for  the 
uterus,  but  they  all  rest  on  the  fact  that  after  the  organ 
has  initiated  a  large  number  of  impulses  in  the  sympa- 
thetic system,  they  may  be  passed  to  the  cerebro-spinal 
system  at  any  point  of  union  of  the  two  systems. 

Ovary  and  Testes. — These  organs  receive  their  sym- 
pathetic innervation  from  the  plexus  which  lies  on  their 
arteries.  The  ovarian  plexus  is  given  off  from  the  aortic 
plexus  which  receives  fibers  from  as  high  as  the  eleventh 
and  twelfth  dorsal  ganglia.  Therefore  a  lesion  in  the 


232 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   54.     Center  for  the  bladder. 


PRINCIPLES  OF  OSTEOPATHY  233 

area  of  the  eleventh  and  twelfth  spinal  nerves  is  frequent- 
ly in  connection  with  the  ovaries  or  testes.  Fig.  50  indi- 
cates the  height  of  the  influence  of  the  aortic  plexus 
through  its  direct  connection  with  the  cerebro-spinal 
system. 

Kidneys.- — Fig.  51  indicates  the  surface  marking  of 
the  kidneys  and  the  junction  of  the  last  dorsal  and  first 
lumbar  vertebrae.  Lesions  of  either  the  eleventh  or 
twelfth  dorsal  may  affect  the  kidneys. 

The  reflexes  of  this  organ  may  reach  the  cerebro- 
spinal  system  over  the  renal  splanchnic.  The  articulation 
of  the  last  dorsal  and  first  lumbar  allows  considerable 
movement.  It  is  probably  the  weakest  part  of  the  back. 
The  area  of  the  twelfth  dorsal  nerve  is  usually  sensitive 
when  the  kidneys  are  affected.  This  sensitiveness  may 
extend  a  short  way  upward,  as  far  as  the  tenth  dorsal. 

In  patients  whose  abdomen  is  moderately  thin,  it  is 
possible  to  affect  the  renal  sympathetic  plexus  by  deep 
manipulation  above  the  umbilicus.  The  kidneys  lie  above 
the  level  of  the  umbilicus.  Have  the  patient  lie  in  the 
dorsal  position  with  flexed  thighs  so  as  to  relax  the  ab- 
dominal muscles.  The  balls  of  the  fingers  of  both  hands 
should  be  pressed  deeply  into  the  abdomen  about  two 
inches  above  the  umbilicus,  then  move  the  fingers  lateral- 
ly toward  the  kidneys.  Pressure  is  thus  brought  to  bear 
upon  the  renal  artery.  The  mechanical  stimulation  of  the 
renal  plexus  usually  results  in  vaso-constriction  of  renal 
arteries. 

Second  Lumbar. — The  lumbar  enlargement  of  the 
spinal  cord  is  the  physiological  center  for  several  func- 
tions performed  in  the  pelvis.  Defecation,  micturition, 
and  parturition,  are  all  reflexly  controlled  at  this  point, 
second  lumbar.  The  spinal  cord  ends  at  the  lower  border 
of  the  first  lumbar  vertebra.  The  second  lumbar  verte- 
bra is  indicated  in  osteopathic  literature  as  a  center  for 
the  three  functions  named  above.  We  understand  by  this 
that  an  injury  at  this  point  may  involve  the  functional  ac- 


234  PRINCIPLES  OF  OSTEOPATHY 

tivity  of  the  rectum,  bladder,  or  uterus.  Disturbances  in 
these  viscera  are  not  necessarily  manifested  to  the  osteo- 
path by  tenderness  around  the  second  lumbar  vertebra. 
Any  point  along  the  spinal  column  below  the  second 
lumbar  may  be  sensitive  as  a  result  of  disturbance  in  the 
pelvic  viscera.  Fig.  52. 

During  parturition  there  is  conscious  aching  along 
the  whole  lumbar  area,  thus  demonstrating  that  the  sen- 
sory nerves  of  the  uterus  can  reflex  their  irritation  to  all 
the  lumbar  nerves.  Injury  of  the  spinal  column  at  the 
junction  of  the  dorsal  and  lumbar  portions  may  affect  mo- 
tion, sensation  and  nutrition  of  all  the  structures  inner- 
vated by  the  cauda  equina.  An  injury  below  the  second 
lumbar  vertebra  will  not  have  as  far-reaching  effect  as 
an  injury  of  the  same  character  above  that  point. 

Paraplegia. — When  the  back  is  broken  at  the  dorso- 
lumbar  articulation,  paraplegia  results.  It  is  not  necessary 
to  actually  break  the  back  in  order  to  cause  paraplegia. 
A  severe  strain  caused  by  a  fall  may  induce  such  an 
exudate  around  this  articulation  that  pressure  is  exerted 
on  the  lumbar  enlargement  of  the  cord.  Many  of  the  so- 
called  broken  backs,  which  are  spoken  of  as  causative  of 
paraplegia,  are  not  broken  at  all,  but  the  ligaments  are 
badly  sprained.  The  same  condition  exists  here  as  in 
other  sprained  joints.  There  may  be  marked  kyphosis, 
but  this  does  not  necessarily  indicate  dislocation.  The 
paraplegic  condition  may  be  perpetuated  by  the  pressure 
of  connective  tissue  formed  in  the  repair  of  the  injury. 
This  is  especially  liable  to  follow  if  some  form  of  manipu- 
lative treatment  is  not  persisted  in  for  from  one  to  three 
years.  The  author  has  fortunately  been  able  to  observe 
the  slow  regeneration  of  nerve  tissue  following  complete 
paraplegia  as  a  result  of  injury  of  the  dorso-lumbar  ar- 
ticulation. This  case  has  been  observed  by  us  during 
nearly  four  years.  During  all  of  this  time,  she  has  re- 
ceived osteopathic  treatment.  This  method  of  treatment 
was  not  begun  until  ten  months  after  the  accident,  there- 


PRINCIPLES  OF  OSTEOPATHY 


235 


fore,  synovial  adhesions  had  formed  to  such  an  extent  in 
the  joints  of  the  limbs  that  much  painful  manipulation 
of  these  joints  has  been  necessary. 

Following  the  accident,  there  was  motor  and  sensory 
paralysis  of  the  extremities,  bladder  and  rectum.  Control 
of  the  bladder  and  rectum  returned  after  two  months  of 
osteopathic  treatment.  Sensation  and  motion  have  re- 
turned to  the  extremities.  There  is  deformity  as  a  result 


FIG.  55.     Sphygmograms  illustrating  the  effect  of  uterine  reflexes  on  the 
heart. 

of  the  adhesions  formed  during  the  ten  months  previous 
to  the  first  osteopathic  manipulation.  The  patient  had 
been  massaged  during  the  ten  months  mentioned. 

Lumbar  and  Sacral  Plexuses. — From  the  nerves  of  the 
cauda  equina  are  formed  two  large  plexuses,  the  lumbar 
and  sacral,  indicated  in  Fig.  53.  The  branches  of  these 
plexuses  innervate  the  muscles  of  the  lower  extremities. 
The  spinal  area  from  which  these  plexuses  receive  their 
fibers  should  be  carefully  examined  whenever  any  diffi- 
culty of  movement  or  sensation  in  the  lower  extremities 
is  presented. 

The  student  should  learn  the  sensory  and  motor  dis- 
tribution of  each  branch  of  these  plexuses,  so  that  per- 
ipheral disturbance  can  be  immediately  associated  with 
the  point  of  emergence  from  the  spinal  column  of  the 
affected  nerve  or  nerves. 

The  Bladder. — Fig.  54  indicates  the  superficial  area 
in  which  reflexes  from  the  bladder  are  most  frequently 


236  PRINCIPLES  OF  OSTEOPATHY 


FIG.   56.     Surface  marking'  of  the  pudic  nerve. 


PRINCIPLES  OF  OSTEOPATHY  237 

found.  The  sensory  fibers  to  the  bladder  are  found  in 
the  first,  second,  third  and  fourth  sacral  nerves.  The 
first  to  third  give  the  strongest  evidence  of  sensory  dis- 
turbance. When  the  mucous  lining  of  the  bladder  is  con- 
gested, these  sensory  nerves  are  stimulated.  Motor  fibers 
to  the  bladder  are  found  in  the  second  and  third  sacral 
nerves.  The  stimulation  of  the  sensory  nerves  results  in 
/eflex  stimulation  of  the  motor  nerves,  which  cause  con- 
traction of  the  muscular  tissue  of  the  bladder.  Inflamma- 
tion of  the  bladder  is  accompanied  by  almost  continuous 
desire  to  micturate. 

The  sacral  spinal  nerves  take  a  more  direct  and  un- 
interrupted course  to  the  pelvic  viscera  than  do  nerves 
from  other  portions  of  the  spinal  column  to  their  respec- 
tive areas  of  distribution. 

Inhibitory  pressure  over  the  sacral  foramina  has  a 
very  marked  effect  on  the  sensory  nerves  of  the  bladder. 
This  pressure  does  not  directly  affect  the  anterior  divi- 
sions of  the  sacral  nerves,  nevertheless  the  effect  is  the 
same  as  though  the  anterior  divisions  were  subjected  to 
the  inhibitory  pressure.  This  is  evidence  of  the  close 
harmony  between  the  two  divisions  of  a  spinal  nerve. 
The  inhibitory  pressure  not  only  lessens  conscious  pain 
in  the  bladder,  but  also  changes  the  vaso-motor  condi- 
tions. In  this  respect  it  much  resembles  the  action  of 
heat  applied  to  the  surface. 

Sphincter  Vaginae. — The  sphincters  of  the  vagina  and 
rectum  are  controlled  from  the  area  of  the  third  and 
fourth  sacral  nerves.  When  the  vulva,  vagina  or  rectum 
are  highly  sensitive,  we  usually  find  a  hyperaesthetic  area 
at  the  third  and  fourth  sacral  spines.  When  this  area  is 
sensitive,  the  point  where  the  pudic  nerve  crosses  the 
ischiatic  spine  is  also  decidedly  sensitive  to  pressure. 
Fig.  56  indicates  the  superficial  relation  of  the  pudic 
nerve.  This  nerve  is  sensory  and  motor  to  the  skin  and 
muscles  of  the  perineum.  This  point  will  be  found  sen- 


238  PRINCIPLES  OF  OSTEOPATHY 

sitive  when  the  prostate  is  enlarged ;  in  fact,  almost  any 
disorder  of  the  male  sexual  organism  is  accompanied  by 
this  sensitive  condition. 

Inhibitory  movements  over  the  back  of  the  sacrum 
and  ischiatic  spine  will  result  in  relaxation  of  the  perineal 
muscles.  It  affects  spasmodic  stricture  of  the  urethra  in 
a  wonderful  manner.  The  local  anaesthetic  effect  of  in- 
hibition is  not  so  easily  demonstrated  in  any  other  por- 
tion of  the  body  as  in  this  sacral  area. 

When  the  uterus  is  turned  either  backward  or  for- 
ward or  prolapsed,  there  are  impulses  aroused  in  sensory 
nerve  fibers  in  the  rectum  or  bladder.  These  impulses 
are  reflexed  to  the  sacral  area,  while  those  aroused  in  the 
uterus  pass  to  higher  points  in  the  spinal  column.  In- 
hibition of  this  sacral  area  will  have  a  temporary  effect. 
The  only  treatment  worth  while  is  the  correcting  of  the 
position  of  the  uterus. 

Conclusions. — There  are  many  more  so-called  "cen- 
ters" mentioned  by  osteopathic  writers.  We  have  not 
attempted  to  even  recapitulate  those  other  centers  which 
seem  to  us  to  be  quite  too  fanciful  for  practical  use.  The 
centers  mentioned  in  this  chapter  are  those  which  can 
be  demonstrated  in  daily  practice,  and  hence  are  used 
continually,  both  as  guides  for  diagnosis  and  as  indica- 
tions for  the  application  of  manipulative  therapeutics.  No 
sympathetic  spinal  centers  for  "sensation,"  "motion"  or 
"nutrition"  can  be  demonstrated.  These  are  characteris- 
tics of  nerve  fibers  in  general,  and  it  is  entirely  mislead- 
ing to  limit  these  characteristics  to  any  one  portion  of 
the  spinal  column.  Every  osteopathic  center  should  be 
capable  of  demonstration  anatomically,  physiologically 
and  clinically.  Only  those  which  can  pass  this  test  satis- 
factorily are  worthy  of  our  consideration. 


PRINCIPLES  OF  OSTEOPATHY  239 


CHAPTER  XII. 

THE  BACK. 

The  Spinal  Column. — The  back  is  characterized  by  tht 
spinal  column,  which  constitutes  the  long  axis  of  the  body. 
This  column  consists  of  twenty-four  movable  vertebrae, 
the  sacrum  and  coccyx.  The  movable  bony  segments  are 
separated  from  each  other  by  fibre-cartilaginous  discs. 
Each  vertebra  is  characterized  by  a  body  and  an  arch  which 
extends  from  the  posterior  lateral  portions  of  the  body. 
The  body  serves  to  give  strength,  stability  and  weight- 
carrying  capacity  to  the  column.  The  arches  serve  tc 
form  an  incomplete  bony  canal  for  the  protection  of  th< 
spinal  cord  and  its  membranes.  Although  these  arche.* 
form  a  fairly  complete  protection  to  the  contents  of  the 
canal  in  the  upper  dorsal  region,  the  approximation  of  the 
laminae  is  not  nearly  so  perfect  in  the  lumbar  region.  It  is 
through  the  gaps  between  the  laminae  in  the  lumbar  region 
that  puncture  can  most  easily  be  made. 

Spinal  Ligaments. — The  discs  of  fibro-cartilage  are 
very  strongly  attached  to  the  bodies  of  the  vertebrae  and 
the  fibrous  tissue  of  these  discs  interweaves  with  the  fibers 
of  the  common  ligaments  which  extend  from  end  to  end  of 
the  spinal  column  on  the  anterior  and  posterior  surfaces 
of  the  bodies.  After  cutting  the  neural  arches,  at  their 
junction  with  the  bodies,  we  have  left  a  strong  column  of 
bony  segments,  separated  by  fibro-cartilaginous  discs  which 
are  strongly  adherent.  Both  bones  and  cartilages  are  very 
strongly  bound  together  by  the  anterior  and  posterior  com- 
mon ligaments. 


240 


PRINCIPLES  OF  OSTEOPATHY 


Dorsal, 


-Axis  of  rotation 
located  in 
concavity  of 
the  curves  in 
Ceruicai, 


Lumbar. 


FIG.   57.     Drawn  by  John  Comstock. 


241 


Ligara«nium 
OOVU.JTV  or 
svibflavum 


.         mi-lit  utn 
iru«r*pinul« 

M<  Ull*'llt  lltll 

suprasproale 


Vertebral 
body 


Intervertebpol, 
disc 


Nuc-leus 
pulposi 


FIG.    58.     Mesial    section    through    a    portion    of    the    lumbar   part    of   the 
spine.      Drawn    by   John    Comstock    (after    Cunningham). 


Pedicle  o£ 

vertebra 

divided 

Posterior 

common 

ligament 


Intervertebral 
disc. 


FIG  59.  The  posterior  common  ligament  of  the 
vertebral  column.  Drawn  by  John  Com- 
stock (after  Cunningham). 


242  PRINCIPLES  OF  OSTEOPATHY 

Flexibility. — This  column  is  characterized  by  moder- 
ate flexibility  and  certain  curves.  The  elasticity  is  due  to 
the  structure  of  the  fibro-cartilaginous  discs.  The  center 
of  the  discs  is  a  very  soft  mass  of  fibre-cartilage,  thicker 
than  the  margins  and  containing  the  remains  of  the  chorda 
dorsalis  of  the  embryo. 


FIG.  60.  Curves  of  the  vertebral 
column  (Pick).  A,  with  inter- 
vertebral  discs;  B,  without  inter- 
vertebral  discs. 


Normal  Spinal  Curves. — The  curves  are  due  to  the  un- 
equal thickness  of  the  anterior  and  posterior  portions  of 
the  discs.  The  discs  are  thicker  anteriorly  in  the  cervical 
and  lumbar  regions,  thicker  posteriorly  in  the  dorsal  region, 
thus  producing  anterior  curves  in  the  cervical  and  lumbar, 
and  a  posterior  curve  in  the  dorsal.  The  bodies  of  the  ver- 
tebrae also  vary  slightly  in  thickness  anteriorly  and  pos- 
teriorly, i.  e.,  the  anterior  depth  of  the  bodies  is  less  than 
the  posterior  so  that  without  the  discs  the  whole  column 
presents  a  posterior  curve  with  a  loss  of  the  anterior  curves 
in  the  cervical  and  lumbar  regions.  These  curves  and  the 
characteristics  of  the  centers  of  the  inter-vertebral  discs 


PRINCIPLES  OF  OSTEOPATHY  243 

give  the  column  its  resilience.     In  bending  this  column  to 
the  side,  rotation  of  the  vertebral  bodies  is  inevitable. 

Limitation  of  Flexibility. — The  anterior  and  posterior 
common  ligaments  of  this  column  of  vertebral  bodies  and 
inter-vertebral  discs  tend,  by  their  inelastic  fibrous  tissue, 
to  limit  flexibility.  By  adding  the  neural  arches  with  their 
ligaments  the  flexibility  of  the  column  is  still  further  lim- 
ited. Besides  the  common  ligaments  binding  the  bodies 
there  is  one  other  ligament  which  extends  the  whole  length 
of  the  column,  i.  e.,  the  supraspinal  ligament,  consisting  of 
inelastic  fibrous  tissue  extending  over  the  spinous  pro- 
cesses from  the  sacrum  to  the  seventh  cervical,  where  its 
structure  changes  to  yellow  elastic  fiber  and  is  known  as 
the  ligamentum  nuchae  through  its  continuation  to  the 
cervical  spinous  processes  and  the  occipital  bone.  This 
ligament  limits  flexibility  in  the  dorsal  and  lumbar  regions. 
The  remainder  of  the  spinal  ligaments  are  intervertebral, 
i.  e.,  extend  between  two  vertebrae.  They  are  inelastic 
with  one  exception,  the  ligamenta  subflava  connecting  the 
laminae  of  the  neural  arches.  There  are  many  other  things 
which  are  factors  in  limiting  the  inherent  flexibility  of  the 
spinal  column,  viz.,  the  articulation  with  the  ribs  to  form 
the  thorax,  the  articulation  with  pelvic  bones,  the  contents 
of  abdomen  and  thorax  and  the  bulk  of  the  soft  tissues 
which  round  out  the  body. 

Articular  Processes.  —  Although  the  spinal  ligaments 
and  other  structures  limit  the  flexibility  of  the  spinal 
column,  the  character  of  its  evident  flexibility  is  largely 
governed  in  the  various  regions  by  the  shape  and  position 
of  articular  processes,  which  form  a  series  of  gliding  joints 
between  the  neural  arches.  The  articular  processes  are 
located  at  the  junctions  of  the  pedicles  and  laminae.  They* 
consist  of  two  superior  and  two  inferior  for  each  vertebra. 

Cervical  Region. — In  the  cervical  region  the  articular 
processes  are  placed  very  obliquely.  The  surfaces  of  the 
superior  look  upward  and  backward  and  are  somewhat 


244 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   61.     Radiograph  of  the  cervical  region  in  position  for  balancing  the 
head  erect. 


PRINCIPLES  OF  OSTEOPATHY  245 


FIG.   62.     Radiograph  of  the  cervical  region  in  extension. 


246 


PRINCIPLES  OF  OSTEOPATHY 


arched  to  fit  the  slight  concavity  of  the  inferior  which  look 
downward  and  forward.  This  arrangement  permits  flexion, 
extension  and  side  bending  accompanied  by  slight  rotation. 
These  are  recognized  as  the  physiological  movements  for 
this  region  of  the  column.  The  highly  specialized  articu- 
lations between  the  occipital  bone  and  atlas,  the  axis  and 


FIG.    63.     Radiograph    illustrating   normal    flexion    in   the    cervical   region. 


PRINCIPLES  OF  OSTEOPATHY 


247 


FIG.    64.     Radiograph   of   the   cervical  region   in   rotation. 


248 


PRIXCIPLKS  OF  OSTEOPATHY 


atlas    are    worthy    of    more    detailed    consideration.      (See 
Chap.  XIV.) 

Dorsal  Region. — The  surfaces  of  the  dorsal  articular 
processes  are  vertical,  the  superior  facing-  backward,  the 
inferior  forward.  The  surfaces  are  slightly  curved  from 
side  to  side  thus  forming  parts  of  the  surface  of  a  theo- 
retical cylinder  having  its  axis  located  in  front  of  the  body. 
The  movements  permitted  by  this  structural  arrangement 
are  the  physiological  ones  known  as  flexion,  extension  and 
side  bending  rotation.  Rotation  is  the  most  characteristic 
of  the  movements  in  this  region.  It  is  greatest  in  the  upper 
dorsal  articulations  and  decreases  as  the  articular  processes 
begin  to  take  on  lumbar  characteristics.  The  eleventh, 
sometimes  the  tenth,  dorsal  verterbra  marks  the  limit  of 
this  characteristic  dorsal  movement.  All  movements  are 
limited  in  the  dorsal  region,  not  only  by  the  inherent  form 
of  the  vertebral  articulations  but  also  by  the  attachment 
of  the  ribs.  The  typical  costovertebral  articulation  is  char- 
acterized by  the  head  of  the  rib  articulating  with  the  bodies 
of  two  vertebrae  while  the  tubercle  of  the  rib  unites 
with  the  articular  facet  on  the  transverse  process  of  the 
lower  of  these  two  vertebrae.  The  first,  eleventh  and 


4  tli  cervical, 
left  lateral  vteia. 


—Centre  °f 
rotation 


FIG.  65.     Drawn  by  John  Comstock. 


PRINCIPLES  OF  OSTEOPATHY 


249 


twelfth  costovertebral  articulations  are  exceptions.  The 
junction  of  the  upper  ribs  with  the  sternum  serves  still 
further  to  give  stability  to  the  thorax  and  limit  movement 
in  the  upper  portion  of  the  dorsal  division  of  the  column. 

Lumbar  Region. — The  articular  processes  in  the  lum- 
bar region  are  vertical.  The  surfaces  of  the  superior  and 
inferior  face  almost  directly  inward  and  outward,  respect- 
ively. These  surfaces  are  curved  in  the  opposite  direction 
from  those  in  the  dorsal  region,  so  that  they  would  form 
parts  of  a  theoretical  cylinder  having  its  axis  posterior  to 
the  spinous  process. 

4th  cervical, superior  surface. 


FIG.  66.     Drawn  by  John  Comstock. 


250 


PRINCIPLES  OF  OSTEOPATHY 


Flexion  and  Extension. — Since  the  arrangement  of  the 
articular  processes  is  an  index  to  the  character  of  move- 
ment normally  permitted  between  the  vertebrae  in  the 
various  regions  of  the  spinal  column,  it  is  advisable  that 
we  call  attention  to  a  few  points  concerning  them.  It  is 
readily  seen  that  flexion  is  a  fairly  free  movement  in  all 
portions  of  the  column,  with  the  exception  of  that  portion 
of  the  dorsal  which  articulates  with  the  seven  true  ribs. 
Extension  is  likewise  free  in  these  same  sections,  i.  e., 
where  flexion  is  free  it  is  met  by  fairly  free  extension. 

Side  Bending  Rotation. — Side  bending,  of  a  column 
having  antero-posterior  curves,  is  characterized  by  rota- 

7  th  dorsal,  lateral  viem 


of 
rotation. 


FIG.    67.     Drawn   by  John    Comstock. 


PRINCIPLES  OF  OSTEOPATHY 


-251 


tion.  This  inherent  rotation  of  the  segments  of  the  spinal 
column  will  naturally  take  place  with  a  center  of  rotation 
theoretically  located  on  a  line  extending  directly  from  end 
to  end.  This  line  would  pass  on  the  concave  side  of  the 
curves,  i.  e.,  be  posterior  to  the  bodies  in  the  cervical  region, 
anterior  to  the  bodies  in  the  dorsal  and  posterior  to  the 
bodies  in  the  lumbar.  A  study  of  the  articular  processes 
will  show  how  this  action  is  favored  by  the  facing  of  their 
articular  surfaces.  Lines  drawn  perpendicular  to  the  sur- 
faces of  the  superior  articular  processes  of  a  typical  cerv- 
ical, i.  e.,  the  fourth  or  fifth  cervical,  will  meet  at  a  point 
behind  the  spinous  processes  and  about  three  inches  above 


7th  dorsal,  superior  surface. 


Centre  of 
rotation. 


\ 


FIG.   68.     Drawn  by  John   Comstock. 


252 


PRINCIPLES  OF  OSTEOPATHY 


Gostocentrol 
articulation 


FIG.    6!».      Drawn   by   John    Comstock    (after   Toldt). 


3rd  lumbar,  lateral  vteui. 


FIG.    70. 


PRINCIPLES  OF  OSTEOPATHY 


253 


the  level  of  the  body  of  the  vertebra.     These  lines  incline 
backward,  upward  and  inward. 

Best  Position  for  Freest  Movement.  —  The  range  of 
movement  in  any  joint  is  favored  by  relaxation  of  its  liga- 
ments, therefore  any  characteristic  movement  will  be  greater 
when  the  relation  of  the  joint  surfaces  to  each  other  is 
least  limited  by  the  ligaments.  This  position  will  be  prac- 
tically attained  when  the  surfaces  are  in  their  normal  posi- 
tion for  weight-carrying,  i.  e.,  balance.  The  weight  of  the 
head  upon  the  neck  is  balanced  by  the  muscles  governing 
the  movement  in  the  arthrodial  articulations  so  that  there 
is  no  sense  of  strain.  This  erect  position  favors  rotation. 
The  extent  of  rotation  diminishes  as  the  neck  is  flexed.  It 

3rd  lumbar,  superior  surface. 


FIG.    71. 


254 


PRINCIPLES  OF  OSTEOPATHY 


also  diminishes  as  the  neck  is  extended.  In  either  flexion 
or  extension,  a  series  of  ligaments  becomes  tense  and  hence 
limits  the  extent  of  another  movement,  which  requires  free- 
dom of  this  tense  ligament.  The  erect  position  of  the  neck 


FIG.  72.  Left  dorsal — right  lumbar 
curvature,  progressive  in  type 
and  therefore  painful.  Bodies  ot 
the  dorsal  vertebrae  rotated  to 
the  left.  Bodies  of  the  lumbar 
vertebrae  rotated  to  the  right. 


FIG.  73.  Bodies  of  the  lumbar  ver- 
tebrae are  rotated  into  proper 
alignment  by  elevating  right  but- 
tock. 


signifies  ligamentous  relaxation  and  is  therefore  the  posi- 
tion of  election  for  reducing  subluxations  in  the  cervical 
region.  The  seventh  cervical  marks  the  change  in  direction 
of  the  facing  of  the  articular  processes.  Its  superior  sur- 


PRINCIPLES  OF  OSTEOPATHY 


255 


faces  adhere  to  cervical  characteristics  while  its  inferior 
become  more  vertical  and  lines  perpendicular  to  them  meet 
at  a  point  in  front  of  the  column.  There  is  frequently  a 
gradual  change  in  the  facing  of  the  cervical  articular  pro- 


FIG.  74.  Shows  greatest  right  lat- 
eral flexion  in  concavity  of  the 
dorsal  curve. 


FIG.  75.  Shows  greatest  left  lat- 
eral flexion  in  concavity  of  the 
lumbar  curve. 


cesses  which  begins  at  the  sixth  cervical.  The  inferior 
processes  of  the  sixth  may  face  so  as  to  bring  their  per- 
pendicular lines  together  in  front  of  and  below  the  body. 

Rotation  in  the  Dorsal  Region.  —  The  articular  pro- 
cesses in  the  dorsal  are  characteristically  vertical  and  theo- 
retically move  in  line  with  the  surface  of  a  cylinder  having 
its  axis  anterior  to  the  bodies  of  the  vertebrae.  Thus  ro- 
tation in  the  dorsal  appears  to  move  on  a  fixed  point,  just 
anterior  to  the  bodies  of  the  vertebrae  and  hence  the  spinous 


256 


PRINCIPLES  OF  OSTEOPATHY 


processes  make  an  actually  as  well  as  apparently  greater 
excursion  to  right  or  left.  The  same  rule  with  relation  to 
freedom  of  movement  being  greatest  in  the  normal  poised 
position,  applies  here.  Rotation  is  greater  in  the  upper 


FKJ.  7<>.  Illustrates  the  degree  of 
rotation  of  the  bodies  of  the 
lumbar  vertebrae  in  this  case  of 
loft  dorsal-right  lumbar  lateral 
curvature. 


FIG.  77.  Illustrates  the  degree  of 
rotation  of  the  bodies  of  the  dor- 
sal vertebrae  in  this  case  of  left 
dorsal-right  lumbar  lateral  curv- 
ature. 


dorsal  and  decreases  downward,  disappearing  at  the  vari- 
able point  where  lumbar  characteristics  begin  to  influence 
the  form  of  the  articular  processes.  This  variable  point  is 
found  from  the  ninth  to  eleventh  dorsal.  Rotation  with 
the  axis  of  movement  anterior  to  the  vertebral  body  usu- 
ally ceases  at  the  articulation  between  the  eighth  and  ninth 
dorsal.  The  lateral  flexion  between  the  ninth  and  tenth, 
tenth  and  eleventh  and  eleventh  and  twelfth,  is  character- 
ized by  very  little  rotation  of  either  the  dorsal  or  lumbar 


257 


type.  In  this  short  region  of  the  dorsal  we  have  an  almost 
pure  lateral  flexion.  Rotation  in  the^  upper  dorsal  is  de- 
creased in  the  flexed  or  extended  position,  for  the  same  rea- 
sons given  for  the  cervical.  All  movements  in  the  upper 
dorsal  are  lessened  by  the  costovertebral  articulations.  Since 
the  head  of  a  rib  articulates  with  the  bodies  of  two  vertebrae 


FIG.  78.  Structural  lateral  curva- 
ture in  the  upper  dorsal  region, 
due  to  partial  paralysis  of  the 
left  rhomboideus  major  and 
minor.  Compensatory  rotation 
has  taken  place  in  the  lumbar 
region,  as  shown  by  the  relative 
outline  of  the  body. 


258 


PRINCIPLES  OF  OSTEOPATHY 


and  their  interovertebral  disc,  it  is  apparent  that  this  would 
tend  to  block  the  movement  of  one  vertebra  on  the  other 
and  hence  greatly  limit  rotation.  Although  a  study  of  the 
mechanics  of  this  portion  of  the  column  seems  to  show  a 


Fin.  T'.i.  Fiexion  to  the  left,  in  case 
siiown  in  preceding  illustration. 
The  point  of  greatest  flexion  is 
located  in  tiie  concavity  of  the 
right  iumbar  curve. 


FIG.  SO.  Flexion  to  the  right,  in 
case  shown  in  the  preceding  il- 
lustration. The  point  of  great- 
est flexion  to  the  right  is  about 
the  ninth  dorsal,  i.  e.,  about  the 
center  of  the  concavity  of  the 
left  lateral  part  of  the  curvature. 


very  solid  and  unyielding-  construction,  the  fact  exists  that 
we  have  a  considerable  amount  of  movement  in  the  upper 
dorsal  articulations.  Rotation  is  probably  the  most  pro- 
nounced of  the  upper  dorsal  movements  and  it  is  in  this 
region  of  the  column  lateral  subluxations  are  found. 
Flexion  and  extension  are  readily  demonstrated  from  first 
to  fourth  and  from  eighth  to  twelfth  dorsal,  i.  e.,  in  these 
regions  they  are  more  pronounced  than  in  the  mid-dorsal. 


PRINCIPLES  OF  OSTEOPATHY  259 

Characteristic  Movement  in  the  Lumbar  Region. — The 
lumbar  articular  processes  are  vertical  -and  face  so  that 
they  move  in  line  with  the  surface  of  a  theoretical  cylinder 
having  its  axis  running  in  the  tips  of  the  spinous  processes. 


FIG.  81.  Slight  lateral  curvature 
of  the  structural  type,  as  is  evi- 
denced by  rotation  of  the  bodies 
of  the  lower  dorsal  vertebrae  to 
the  left,  the  bodies  of  the  lumbar 
to  the  right. 


There  is  much  variation  in  the  form  of  the  lumbar  articu- 
lar surfaces.  Since  they  have  much  greater  weight  for  their 
bearing  surfaces  to  support  they  are  heavily  developed. 
Exaggeration  of  the  normal  lumbar  curve  during  the  de- 


260 


PRINCIPLES  OF  OSTEOPATHY 


veloping  period  causes  them  to  take  on  a  greater  weight 
carrying  function -than  normal  and  hence  changes  the  bear- 
ing movable  surface  so  as  to  decrease  the  range  of  move- 
ment. The  more  nearly  the  bodies  of  the  vertebrae  tend 


Ki.  S2.  Lateral  flexion  to  the 
riKiit.  is  greatest  in  rimcavity  ol 
the  uorsai  curvature. 


FIG.  S3.  Lateral  flexion  to  the  left, 
in  tiiis  case,  is  greatest  in  con- 
cavity of  the  lumbar  curve. 


to  support  the  superincumbent  weight  the  greater  freedom 
of  movement  will  naturally  exist  in  the  arthrodials  between 
the  articular  processes.  The  characteristic  form  of  the 
lumbar  articular  surfaces  is  not  conducive  to  rotation,  as 
a  well  defined  movement,  such  as  we  find  in  the  upper 
dorsal  and  cervical,  but  nevertheless,  side  bending  in  this 
region  is  characterized  by  rotation  having  its  center  in  a 
line  drawn  vertically  through  the  spinous  processes.  Thus 
we  note  that  rotation  in  the  three  regions  of  the  column 


PRINCIPLES  OF  OSTEOPATHY 


261 


places  the  center  of  movement  on  the  concave  side  of  the 
curve.  Any  corrective  movements  made  with  reference  to 
any  portion,  or  the  column  as  a  whole,  must  be  made  with 
reference  to  these  points  of  normal  rotation.  As  in  the 


FIG.  84.  Illustrating  the  presence 
of  rotation  in  the  lumbar  region, 
coexistent  with  lateral  curvature. 

other  regions  of  the  column,  rotation  in  the  lumbar  is  less- 
ened proportionally  by  flexion  or  extension.  Flexion  is 
a  greater  check  in  this  region  than  extension. 

Rotation  Toward  Concavity  of  a  Curve. — It  is  readily 
noted  that,  in  each  region  of  the  column,  movement  toward 
the  concavity  of  the  curve  is  less  of  a  check  on  rotation 


262  PRINCIPLES  OF  OSTEOPATHY 

than  the  reverse.  Movement  in  the  opposite  direction  com- 
presses the  intervertehral  disks  and  hence  lessens  their  resi- 
lience. 

Adaptability  of  Position  to  Body  Weight. — Flexion  and 
extension  in  the  lumbar  are  normally  quite  free,  hence  there 


Kid.  85.  Illustrating  the  presence 
of  rotation  in  the  dorsal  region, 
coexistent  with  lateral  curvature. 


is  great  adaptability  to  the  position  of  the  body  weight. 
A  decided  deviation  of  a  single  spinous  process  is  seldom 
found  in  this  region.  The  direction  of  the  articular  sur- 
faces tends  to  prevent  such  deviation. 


PRINCIPLES  OF  OSTEOPATHY 


263 


CHAPTER  XIII. 

THE  PELVIS. 

The  Fifth  Lumbar. — The  fifth  lumbar  vertebra  pre- 
sents some  points  of  importance.  Its  massiveness  is  an 
evidence  of  its  weight-carrying  capacity.  The  depth  of  its 
anterior  margin  is  markedly  greater  than  that  of  the  pos- 
terior portion  of  its  body.  The  intervertebral  disc  between 
the  fifth  and  the  sacrum  still  further  accentuates,  by  the 
relatively  great  thickness  of  its  anterior  margin,  the  angle 
formed  by  the  articulation  of  the  fifth  with  the  sacrum.  The 
inferior  articular  processes  are  wider  apart  than  those  of 


FIG.    86.     Drawing    of    pelvis,     showing    sacro-vertebral    angle. 
Drawn   by   John   Comstock    (after   Holden). 


264  PRIXCIPI.KS  OF  OSTKOPATHY 

other  lumbars.  The  transverse  processes  are  usually 
heavily  developed,  but  the  spinous  process  is  apt  to  be 
smaller  than  those  of  the  other  lumbars.  This  vertebra 
joins  the  sacrum  at  a  rather  abrupt  angle  forming  a  de- 
cided projection,  the  sacro-vertebral  angle.  A  line  drawn 
through  the  intervertebral  disc  between  the  fifth  lumbar 
and  the  sacrum  would  form  an  angle  with  the  horizontal 
of  about  30  degrees.  It  is  evident  that  the  inferior  articu- 
lar processes  of  this  vertebra  have  a  considerable  function 
of  weight  carrving.  If  it  were  not  for  the  bracing  action 
of  these  processes,  the  superincumbent  weight  would  tend 
to  slide  the  body  of  the  fifth  forward  on  the  base  of  the 
sacrum. 

Loss  vs.  Exaggeration  of  Normal  Curves. — As  a  gen- 
eral proposition,  it  may  be  stated  that,  the  loss  of  a  normal 
curve  in  the  spinal  column  is  apt  to  cause  more  discomfort 
than  would  the  exaggeration  of  a  normal  curve.  There  is 
probably  no  better  example  of  this,  than  the  effects  noted 
in  changes  of  the  lumbo-sacral  articulation.  It  is  mani- 
fest that  extension  in  the  arthrodial  articulations,  between 
the  articular  processes  of  these  two  bones,  serves  to  hold 
them  more  firmly  together  and  make  the  sacro-vertebral 
angle  more  prominent.  This  serves  to  make  the  lower  ab- 
domen more  prominent  and  makes  the  line  of  division  be- 
tween abdomen  and  pelvis  more  marked. 

Motion  in  Lumbo-Sacral  Articulation. — Flexion,  of  the 
fifth  on  the  sacrum,  compresses  the  thick  anterior  margin 
of  the  intervertebral  disc  and  slides  its  articular  processes 
upward  on  those  of  the  sacrum,  thus  tending  to  greatly  de- 
crease the  sacro-vertebral  angle  and  make  the  spinous  pro- 
cess of-  the  fifth  become  more  prominent.  It  is  conceiv- 
able that  forced  flexion  in  this  articulation  could  cause  a 
complete  dislocation  of  the  articular  surfaces.  Flexion 
and  extension  are  so  free  in  this  articulation  that  much  of 
the  movement,  ascribed  to  the  lumbar  region  as  a  whole, 
is  contributed  by  it.  Loss  of  motion  here,  as  in  lumbago, 


PRINCIPLES  OF  OSTEOPATHY 


265 


Last  lumbar  •  spine 


FIG.    87.     Showing    sacro-vertebral    angle    of    the    average    female    pelvis. 
Drawn    by   John    Comstock    (after   Crossen) 


266 


PRINCIPLES  OF  OSTEOPATHY 


is  characterized  by  a  rigidity  which  causes  the  stride  in 
walking  to  be  greatly  shortened. 

Adaptation  in  Lumbo-Sacral  Articulation. — In  cases  of 
unequal  length  of  legs  as  a  result  of  injury,  flat-foot,  slight 
bend  of  an  inflamed  knee  or  hip,  there  is  a  tilting  of  the 
fifth,  on  the  base  of  the  sacrum,  in  order  to  balance  the 
weight  of  the  body.  There  is  unequal  movement  in  the 


KIG  SS.  Normal  poise  of  the  body. 
Drawn  by  John  Comstock  (after 
Holclon) 

arthrodials  formed  by  the  articular  processes,  i.  e.,  the  joint 
on  the  side  of  the  shorter  leg  extends,  while  the  opposite 
one  flexes,  thus  producing  a  tendency  to  rotate.  This  rock- 
ing action  permits  a  great  range  of  adaptation  in  this  joint, 
an  action  which  is  absolutely  essential  to  the  maintenance 
of  balance  in  the  upright  position. 

Stability  of  the  Lumbo-Sacral  Articulation. — The  an- 
terior common  ligament  is  so  placed  as  to  lend  support  to 


PRINCIPLES  OF  OSTEOPATHY 


267 


FIG.  89.  Plantar  impression  of  a  case  that  sought  relief  for  a  sacro- 
liiac  subiuxation.  The  use  of  an  arch  support  corrected  the  supposed 
lesion.  The  effort  at  adaptation  in  tne  iumbo-sacral  articulation 
caused  a  fatigue  pain. 


268  PRINCIPLES  OF  OSTEOPATHY 

this  articulation  in  the  extended  position.  Ligaments  or- 
dinarily limit  motion  but  are  extensible  tissues  when  under 
continuous  strain,  hence  the  weight  of  the  body  tends 
always  to  be  transmitted  from  bone  to  bone.'  To  change 
this  arrangement  and  thus  put  the  strain  continuously  on 
ligamentous  tissue,  leads  to  relaxation  in  the  joint.  There 
are  many  joints  in  the  body  which,  so  far  as  the  adapta- 
tion of  the  articulating  surfaces  of  the  bones  which  form 
them  arc  concerned,  furnish  no  stability.  The  knee  joint 
is  a  good  example  of  this.  It  has  sixteen  ligaments  which 
serve  to  furnish  it  a  stability  not  warranted  by  the  form 
of  the  articulating  surfaces  of  tibia  and  femur.  The  lumbo- 
sacral  articulation  has  a  stability  in  its  normal  angle  due  to 
the  locking  of  its  articular  processes.  The  more  these  pro- 
cesses are  locked,  as  in  hyperextension,  the  greater  the  ten- 
dency to  transmit  weight  through  them.  This  is  unnat- 
ural and  hence  produces  fatigue,  both  by  continuous  pres- 
sure on  the  articular  surfaces  and  by  stretching  of  the  an- 
terior common  ligament.  This  is  the  condition  caused  by 
a  pendulous  abdomen. 

Decompensation  of  the  Lumbo-Sacral  Articulation. — 
Flexion  of  the  lumbo-sacral  articulation  causes  a  straight- 
ening of  the  lumbar  thus  bringing  the  weight  of  the  body 
more  completely  on  the  column  of  bodies  and  changing 
the  lumbo-sacral  angle,  so  that  the  axis  of  the  pelvic  cavity 
is  brought  more  nearly  in  line  with  that  of  the  abdomen. 
The  obliteration  of  the  normal  lumbar  curve  produces  a 
general  curve,  i.  e.,  coincides  with  the  dorsal  and  thus  be- 
comes part  of  a  general  posterior  curve.  This  puts  a  great 
strain  on  the  posterior  spinal  ligaments.  This  is  a  state  of 
decompensation  of  the  normal  spinal  curves,  which  necessi- 
tates a  decided  effort  to  balance  the  body. 

Part  of  the  Pelvis. — Obstetricians  count  the  fifth  lum- 
bar as  a  part  of  the  pelvis,  since  it  is  bound  to  the  innomi- 
nates  by  ilio-lumbar  ligaments,  which  extend  from  the  tips 
of  its  transverse  processes  to  the  crests  of  the  ilia.  These 
ilio-lumbar  ligaments  tend  to  compel  the  fifth  lumbar  verte- 


PRINCIPLES  OF  OSTEOPATHY 


269 


bra  to  act  somewhat  as  though  it  were  a  portion  of  the 
solid  pelvis. 

Characteristics  of  the  Sacro-Iliac  Articulations. — The 
articulations  between  the  sacrum  and  innominates  are  nor- 
mally immovable.  They  may  become  physiologically  mov- 
able, in  the  pregnant  woman,  in  order  to  facilitate  the  birth 
of  the  child,  i.  e.,  they  exhibit  functional  adaptation.  Fol- 
lowing the  act  of  parturition  they  normally  become  immo- 
bile, i.  e.,  exhibit  functional  adaptation  to  weight  carrying. 
Failure  of  either  of  these  forms  of  adaptation  is  an  abnor- 
mality. In  case  the  articulations  do  not  relax  in  the  par- 
turient woman,  the  whole  process  of  adapting  the  birth 
canal  and  its  contents,  is  exhibited  by  the  head  of  the  child. 
Normally  the  bony  birth  canal  and  the  child's  head  mutu- 
ally undergo  adaptive  changes.  In  case  these  articulations 


/Pbstcrior 


Section  through 
5ocro -iliac  Joint. 

FIG.  90.     Drawn  by  John  Comstock. 


270 


PRINCIPLES  OF  OSTEOPATHY 


do  not  regain  comparative  immobility,  following  parturi- 
tion, a  condition  of  instability  will  exist,  which  will  express 
itself  in  a  disturbance  of  the  statics  of  the  body.  Balancing 
and  weight-carrying  functions  will  be  injured. 

Physiological  Relaxation. — The  menstrual  periods  in 
many  women  are  characterized  by  relaxation  of  the  pelvic 
ligaments,  with  consequent  disturbance  of  the  weight-carry- 
ing power  of  the  sacro-iliac  articulations. 

The  Male  Pelvis. — The  male  pelvis  never  exhibits  any 
form  of  normal  relaxation  of  ligaments,  therefore  the  ex- 
istence of  any  instability  in  the  sacro-iliac  articulations  is 
pathological,  i.  e..  due  to  debility  or  trauma.  The  trauma 
may  be  direct  and  forceful  enough  to  strain  the  ligaments 
suddenly,  or  it  may  consist  in  a  form  of  fatigue,  which 
eventually  allows  the  ligaments,  engaged  in  the  weight- 
carrying  functions  of  these  joints,  to  become  strained. 


FIG.  91.  Drawing  of  posterior  aspect  of  pelvis,  showing  relation  of 
second  sacrai  to  the  posterior  superior  iliac  spines.  Drawn  by  John 
Comstock. 


PRINCIPLES  OF  OSTEOPATHY  271 

Loss  of  Stability. — It  is  axiomatic  that  loss  of  sta- 
bility, in  the  pelvic  girdle,  will  weaken  its  weight-carrying 
capacity  and  hence  disturb  the  normal  static  condition  of 
the  whole  body.  In  view  of  this  fact,  we  must  make  a 
rather  careful  study  of  the  structure  of  these  joints  and 
note  any  evidences  of  inherent  weakness,  i.  e.,  observe  at 
what  points  unusual  force  might  most  easily  produce  a 
lesion. 


FIG.   92.     Normal  relations  of  sacrum  and  ilium. 

Analysis  of  Sacro-Iliac  Articulations.  —  Dissection  of 
these  joints  discloses  the  existence  of  the  same  structures 
found  in  other  joints,  i.  e.,  bone,  cartilage,  synovial  mem- 
brane and  ligaments.  The  fact  that  these  structures  do 
exist  in  the  sacro-iliac  articulations,  naturally  classifies 
these  joints  as  having  possible  mobility.  These  joints 
serve  to  absorb  shocks  transmitted  through  the  legs  to  the 
pelvic  girdle.  The  slight  movement,  normally  possible  in 
them,  subjects  them  to  much  the  same  conditions  which 
serve  to  injure  other  joints. 


272 


PRINCIPLES  OF.  OSTEOPATHY 


FIG.    1)3.     liiuni    forced  upward  and   forward. 


FIG.   94.     Ilium   forced  upward  and  backward. 


PRINCIPLES  OF  OSTEOPATHY 


273 


Relation  of  Sex  to  Sacro-Iliac  Lesions. — Clinically  we 
have  found  disturbances  of  these  joints  in  both  men  and 
women,  hence  we  are  forced  to  believe  that  sex  does  not 
control  the  character  of  the  lesions.  They  are  much  more 
frequent  in  women  than  in  men.  This  is  undoubtedly  due 
to  the  necessarily  greater  functional  adaptability  of  the  fe- 
male pelvis. 

Inherent  Weakness  in  the  Character  of  the  Structure. 
— The  sacro-iliac  articulations  are  inherently  weak,  so  far 
as  any  bony  interlocking  is  concerned.  Their  stability  is 
a  matter  of  ligamentous  strength.  The  sacrum  is  wedge- 
shaped  from  above  downward  and  from  anterior  to  posterior. 
The  anterior  surface,  being  broader  than  its  posterior,  does 
not  serve  well  to  offer  resistance  to  the  superincumbent 
weight  of  the  spine.  The  sacrum  articulates  by  its  auricular 
surfaces  with  those  of  the  ilia.  The  articulating  surfaces 
of  both  bones  are  covered  with  cartilage.  The  joints  are 
surrounded  by  capsular  ligaments  and  contain  synovial 


FIG.  95.     Posterior  superior  spine  of  the  ilium  is  too  prominent. 


274  PRINCIPLES  OF  OSTEOPATHY 


Kl<;.    !it;.     Normal    surface    markings   of    the   relations    of    the   sacrum   and 
ilia. 


PRINCIPLES  OF  OSTEOPATHY  275 

sacs.  The  apposing  auricular  surfaces  are  reciprocally, 
slightly,  uneven  but  not  enough  so  to  sustain  any  weight 
without  ligaments.  The  illustration,  Fig.  90,  shows 
clearly  the  relation  of  the  form  of  the  sacrum  to  the  direc- 
tion of  the  weight  it  sustains.  The  structure  of  the  sacro- 
iliac  synchondroses  indicates  that  movement  is  possible 
and,  in  fact,  probable.  The  primary  object  of  the  move- 
ment is  to  produce  elasticity  in  the  pelvic  girdle  and  inter- 
rupt shocks  which  would  be  transmitted  from  the  legs  to 
the  trunk.  A  further  object  would  be,  in  the  female,  adapta- 
tion of  the  birth  canal  to  its  contents. 

Causes  of  Subluxations.- — Clinically  we  recognize  the 
existence  of  disturbances  in  these  joints  as  clue  to  relaxa- 
tion of  ligaments  due  to  pregnancy,  menstruation,  general 
debility,  or  trauma.  Functional  adaptability  in  the  female 
pelvis  makes  women  easily  subject  to  changes  in  these 
joints,  and  likewise  permits  easier  correction.  The  male 
pelvis  is  practically  never  disturbed  except  as  result  of 
debility  or  trauma,  and  is  therefore  more  difficult  to  correct. 

Rotation. — The  motion  in  these  joints  is  described  by 
various  authors.  Judging  from  clinical  experience  the  mo- 
tion seems  to  be  in  the  nature  of  rotation.  This  rotation 
takes  place  on  an  axis  which  passes  through  the  articulat- 
ing surfaces  of  the  sacrum  and  ilia  on  a  level  with  the  pos- 
terior superior  spines  of  the  ilia  and  the  second  sacral 
spine.  This  makes  the  second  sacral  spine  and  the  pos- 
terior superior  spines  of  the  ilia  the  bony  landmarks  indi- 
cating the  position  of  the  joint  surfaces.  Rotation  of  the 
ilium  forward  would  make  the  posterior  superior  spine  less 
prominent  and  slightly  higher,  so  that  a  line  drawn  across 
the  sacrum  through  its  second  soinous  process  would  pass 
through  the  lower  border  of  the  posterior  superior  spine, 
instead  of  its  apex.  Rotation  of  the  crest  of  the  ilium  back- 
ward makes  the  posterior  superior  spine  more  prominent 
and  slightly  lower  than  normal.  All  the  positions  described 
by  various  authors  can  be  reduced  by  analysis  to  the  two 


276  PRINCIPLES  OF  OSTEOPATHY 


KM;.    !i7.      notation   of    the    ilium,    forward. 


PRINCIPLES  OF  OSTEOPATHY 


27; 


FIG.    98.     Posterior    superior    spine    of    the    ilium    is    prominent,    anG 
slightly  below  the  second  sacral  spine. 


278 


PRINCIPLES  OF  OSTEOPATHY 


rotations  just  described.  Since  these  rotations  are  unilat- 
eral, the  pelvic  distortion  results  in  a  slight  apparent  dif- 
ference in  the  length  of  the  legs  so  that  when  the  patient 
lies  on  the  back,  on  a  hard  surface,  with  the  legs  stretched 
out  as  evenly  as  possible,  the  heels  will  be  found  not  to  be 
equal.  In  order  to  compensate  for  this  apparent  inequality 
in  length,  the  pelvis  will  be  found  to  be  tilted,  with  relation 
to  the  spinal  column.  This  compensatory  tilt  is  the  same 
phenomenon  that  is  present  in  every  case  having  unequal 


FIG.  99.  A  case  of  posterior  right 
iliac  which  was  characterized  by 
persistent  pain  in  the  right  sacro- 
iiiac  and  the  sacro-vertebral  ar- 
ticulations. 


PRINCIPLES  OF  OSTEOPATHY  279 

length  of  leg  support.  In  order  to  make  sure  which  joint 
is  the  one  at  fault,  one  must  use  those  bony  landmarks 
which  are  a  part  of  the  pelvis,  i.  e.,  posterior  superior  iliac 
spines  and  the  second  sacral  spine.  An  apparent  difference 
in  the  length  of  the  legs  might  be  due  to  a  lumbar  condi- 
tion, irrespective  of  any  change  in  the  relation  of  the  bones 
of  the  pelvis. 

Compensatory  Pelvic  Tilt. — It  should  be  remembered 
that  no  change  in  a  sacro-iliac  synchondrosis  is  ever  unac- 
companied by  a  compensatory  effort  of  the  body  to  trans- 
mit the  body  weight  through  the  normal  half  of  the  pelvis. 
This  produces  a  slight  spinal  curvature,  which  is  part  of 
the  compensatory  tilt  of  the  pelvis,  to  avoid  transmitting 
body  weight  through  the  weakened  joint  of  the  pelvic  girdle. 

Classes  of  Cases. — Two  classes  of  cases  complain  of 
pain  which  may  be  traced  to  disturbance  in  these  joints. 
The  first  group  comprises  those  of  both  sexes,  who  are 
debilitated,  and  hence  do  not  have  normal  tone  in  muscles 
and  ligaments.  These  cases  either  are  bed-fast  or  inclined 
to  assume  the  recumbent  position.  Cases  compelled  to  lie 
on  the  back  for  a  long  period  following  surgical  operations 
are  apt  to  suffer  distress  in  these  joints.  The  second  group 
comprises  those  who  are  over-weighted  in  the  abdomen, 
and  hence  tend  to  lordosis  in  the  lumbar  region.  Both  of 
these  classes  are  greatly  helped  by  corrective  manipula- 
tion and  bandages. 

The  debilitated  individual  is  toned  by  corrective  man- 
ipulation, and  the  weakened  ligaments  reinforced  by  some 
simple  form  of  girdle  which  helps  to  hold  the  pelvis  firm. 
The  individual  with  the  over-weighted  abdomen  is  physio- 
logically rested  by  corrective  manipulation  and  the  use  of 
a  support  which  will  assist  the  back  in  carrying  the  ex- 
cessive weight  which  lies  anterior  to  its  normal  weight- 
carrying  structure. 

The  really  difficult  sacro-iliac  lesion  to  correct  is  the 
traumatic.  Such  a  lesion  has  all  the  elements  which  make 
perfect  recuperation  problematical  in  any  joint. 


2SO 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  100.  Elevation  of  tnc  foot  in 
a  case  of  posterior  rotation  01 
the  right  liium.  This  is  not  suf- 
ficient, in  such  eases,  to  correct 
the  compensatory  changes  in  the 
lumbar  articulations. 


PRINCIPLES  OF  OSTEOPATHY 


281 


Symptoms. — The  symptoms  of  sacro-iliac  lesions  are 
usually  pains  located  in  the  lumbar,  gluteal  and  thigh  re- 
gions. The  pains  are  described  by  patients  as  being  usu- 
ally a  dull  heavy  ache  whenever  the  weight  of  the  body 
is  transmitted  through  these  joints.  Close  analysis  will  be 
required  to  determine  whether  a  given  case  is  in  reality  a 
sacro-iliac  lesion.  The  only  physical  test  worth  trusting  is 
the  alignment  of  the  posterior  superior  iliac  spines  and  the 
second  sacral  spine,  when  the  patient  is  standing.  The  pains 
may  be  due  to  many  different  strains.  The  hyperesthetic 
points  about  the  sacro-iliac  joints  may  accompany  other 
conditions.  Flat-foot  will,  in  some  instances,  produce  all 
the  sore  spots  in  the  lumbar  and  sacral  region  which  may 
be  present  with  a  sacro-iliac  lesion.  The  backache,  due  to 
tilting  of  the  pelyis,  to  compensate  for  a  sacro-iliac  lesion,  is 
practically  similar  to  that  due  to  the  effort  to  compensate 
for  a  change  in  statics  due  to  flat-foot. 

Plan  of  Treatment. — A  sacro-iliac  subluxation  is  due 
to  relaxation  of  ligaments,  or  trauma.  To  correct  such 


FIG.    101.     Showing   the   average   amount   of   inequality   in   the   length 
of  the  legs  in  a  case  of  posterior  rotation  of  the  right  ilium. 


282  PRINCIPLES  OF  OSTEOPATHY 

suhluxations,  the  cause  is  the  controlling  factor  as  to  the 
means  to  be  employed,  i.  e.,  debility  must  be  controlled 
by  general  means,  so  that  local  reinforcement  of  weakened 
ligaments  will  not  be  continuously  necessary.  It  is  usu- 
ally easy  to  make  a  specific  correction  of  the  lesion  in  a 
debilitated  case,  but  not  easy  to  maintain  the  correction. 
It  is  difficult  to  correct  a  traumatic  lesion,  but  when  once 
corrected,  the  vitality  of  the  tissues  tends  to  make  the  cor- 
rection permanent.  In  all  debilitated  cases  voluntary  exer- 
cise must  form  an  important  part  of  the  treatment.  Climb- 
ing on  rough  ground  is  the  best  aid  in  such  cases,  because 
no  two  steps  are  alike,  and  hence  the  tissues  are  not 
fatigued  by  repetitions  of  similar  movements. 


PRINCIPLES  OF  OSTEOPATHY  283 


CHAPTER  XIV. 

SUB  LUXATIONS. 

Definition. — The  word  subluxation  was  so  new,  to  the 
general  medical  profession,  that  much  ridicule  was  heaped 
upon  the  osteopaths  because  they  advocated  such  a  ridicu- 
lous theory  as  that  "all  diseases  are  caused  by  dislocation  of 
bone."  We  are  not  so  sure  but  that  this  ridicule  was,  to  a 
large  extent,  well  merited  by  the  osteopaths.  The  loose  way 
in  which  the  words  luxation,  dislocation  and  subluxation  are 
used  in  some  of  our  literature  shows  that  they  do  not  always 
cover  a  definite  idea  in  the  mind  of  the  writer.  They  can 
not  be  used  interchangeably.  The  word  subluxation  should 
be  used  to  denote  a  definite  condition.  Subluxation  is  de- 
fined as  a  partial  dislocation  in  which  the  normal  relations 
of  the  articulating  surfaces  are  but  slightly  changed. 

Da  Costa  describes  subluxation  of  the  shoulder,  also  of 
the  head  of  the  radius.  For  the  latter  condition  he  has  col- 
lected eight  different  explanations.  We  have  not  been  able 
to  find  the  term  used  in  reference  to  any  other  articulations. 
The  osteopath  uses  the  term  to  define  certain  inequalities  in 
the  arrangement  of  vertebrae  and  ribs,  sacro-iliac  and  other 
articulations.  Perhaps  we  hear  the  term  used  in  connection 
with  the  atlas  more  than  with  any  other  bone. 

Characteristics  of  Subluxations. — Subluxations  allow 
considerable  movement  in  the  articulation,  but  to  the  trained 
hand  there  are  evidences  of  malposition.  Pain  is  developed 
when  the  complete  normal  movement  is  attempted  by  the 
operator.  Digital  pressure  around  the  joint  causes  deep 
pain.  There  is  usually  a  history  of  accident,  exposure  or 
visceral  disorder. 


284 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    102.     Normal    surl'ac-c    marking   of    the    transverse   process   of    Ihe 
Atlas. 


PRINCIPLES  OF  OSTEOPATHY  285 

Primary  or  Secondary  Lesions. — From  experience  we 
know  the  frequency  of  very  evident  malpositions  of  verte- 
brae, commonly  spoken  of  as  subluxations,  and  as  being  true 
or  primary  lesions  causing  disordered  function  in  the  area 
of  peripheral  distribution  of  the  nerves  from  that  segment 
of  the  spinal  cord. 

The  Characteristic  Structure  of  Joints. — In  order  to  get 
at  a  true  understanding  of  what  subluxation  is,  we  must 
make  a  careful  study  of  the  structures  which  form  a  joint 
and  their  vital  manifestations.  The  bones  of  the  skeleton  are 
bound  together  by  ligaments  and  muscles.  The  opposing 
surfaces  of  bones  forming  movable  joints  are  covered  with 
cartilage.  The  muscles  execute  and  the  ligaments,  or  soft 
parts  around  a  joint,  limit  the  motions  of  the  articulation. 
All  movable  articulations  have  their  bony  parts  maintained 
in  their  normal  relations  either  by  the  form  of  the. bones  and 
cartilages  attached  to  them  or  by  the  equal  tension  of  all  the 
controlling  muscles.  Enarthrodial  joints  have  freest  move- 
ments and  yet  are  the  least  dependent  on  muscles  for  reten- 
tion of  their  normal  position.  Air  pressure  and  the  form  of 
the  bones  are  responsible  for  the  integrity  of  these  joints. 
These  joints  are  less  frequently  subluxated  than  those  pos- 
sessing more  limited  motion.  Arthrodial  joints  depend  upon 
the  equal  tension  of  their  governing  muscles  to  keep  the 
opposed  surfaces  in  their  proper  relations.  Coordination  of 
the  muscular  tension  is  usually  so  perfect  that  the  joint  sur- 
faces are  perfectly  opposed  to  each  other.  The  disturbance 
of  this  nicely  balanced  muscular  tension  results  in  the  draw- 
ing of  one  or  both  bony  surfaces  away  from  their  true  rela- 
tions ;  not  entirely,  but  sufficiently  to  make  it  possible  for 
the  physician's  fingers  to  note  the  change. 

The  Atlas. — The  atlas  is  placed  not  only  first  in  the  ver- 
tebral column,  but  also  first  in  importance  to  the  osteopath 
on  account  of  the  great  possibilities  for  slight  displacement 
between  it  and  the  occiput.  All  the  conditions  are  present 
which  make  a  very  movable  joint  and  close  at  hand  are  im- 


286 


PRINCIPLES  OF  OSTEOPATHY 


portant  nerves  and  blood  vessels  whose  slightest  maladjust- 
ment causes  instant  disturbance  at  the  very  fountains  of 
fife.  Xo  physical  examination  is  considered  complete  with- 
out noting  accurately  the  position  of  the  atlas.  There  being 
no  spinous  process  all  reckoning  must  be  made  from  the 
transverse  processes. 

Occipito-Atlantal  Articulation. — According  to  Gray's 
Anatomy:  "The  movements  permitted  in  this  joint  are 
flexion  and  extension,  which  give  rise  to  the  ordinary  for- 


F1G.    103.     Abnormal    surface    markings    of    the    transverse    process   of 
the  Atlas. 


PRINCIPLES  OF  OSTEOPATHY  287 

ward  and  backward  nodding  of  the  head,  besides  slight  lat- 
eral motion  to  one  or  the  other  side.  *  *  *  The 
Recti  Laterales  are  mainly  concerned  in  the  slight  lateral 
movement.  According  to  Cruveilhier  there  is  a  slight  mo- 
tion of  rotation  in  the  joint."  According  to  Gerrish  :  *  * 


FIG.    104.     Normal    relations    between    the    alias    and 
occipital  bone. 


"Some  lateral  gilding  is  also  allowed,  by  which  the 
outer  edge  of  the  condyle  on  the  one  side  is  depressed  and 
on  the  other  is  elevated  in  relation  to  its  socket.  Or  the 
movement  may  be  obliquely  lateral,  one  cojidyle  advancing 
slightly  at  the  same  time  that  it  is  depressed  toward  the 
median  line,  while  the  opposite  condyle  takes  the  reverse  po- 
sition. This  is  the  position  of  greatest  stability,  and  is  as- 
sumed in  the  most  easy  and  natural  attitudes.  Lateral  move- 
ments are  restrained  by  the  check  ligaments  and  the  lateral 
parts  of  the  capsules.  No  true  rotation  is  allowed." 


288 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  105.  Normal  relations  be- 
tween the  atlas  and  occipital 
bone. 


FIG.     106.     Right     transverse     pro- 
cess of  the  atlas  too  far  posterior. 


PRINCIPLES  OF  OSTEOPATHY 


289 


FIG.  107.     Right  transverse  process 
of  the  atlas  too  far  posterior. 


FIG.  108.     Twisted  atlas-rotation. 


290 


PR  I  NCI  PL  KS  OF  OSTEOPATHY 


The  capsular  ligaments  are  very  loose,  hence  the 
strength  of  the  joint  lies  in  the  anterior,  posterior  and  lat- 
eral ligaments.  There  is  no  cartilaginous  disk  between  the 
atlas  and  occiput,  hence  motion  is  limited  only  by  the  liga- 
ments named. 


FIG.   1(»9.     Twisted  atlas-rotation. 


If  one  should  judge  of  the  prevalence  of  dislocations  of 
the  atlas  by  the  number  of  times  such  a  condition  is  men- 
tioned in  osteopathic  literature,  we  would  draw  the  conclu- 
sion that  everyone's  atlas  is  dislocated.  The  term  disloca- 
tion is  a  strong  one  and  ought  not  to  be  used  in  connection 
with  the  atlas.  Its  dislocation  would  cause  death  instantly. 
Subluxation  is  the  proper  term  to  use.  Subluxations  can  be 
readily  diagnosed ;  the  fact  that  they  exist  can  not  be 
doubted ;  all  positions  between  the  normal  relations  and 
complete  dislocation  are  possible.  The  complete  dislocation 
of  this  bone  from  the  occiput  means  death;  intermediate  po- 
sitions, subluxations,  mean  irritation  of  nerves  direct 


PRINCIPLES  OF  OSTEOPATHY  291 

and  both  direct  and  indirect  disturbances  of  circulation ;  di- 
rect disturbance  by  pressure  exerted  on  arteries  and  veins, 
indirect  disturbance  by  excitation  of  vaso  motor  nervca. 

The  Causes  of  Subluxations. — It  is  difficult  to  account 
for  these  subluxations  of  the  atlas  without  bringing  in  the 
contraction  of  muscles.  This  seems  to  us  to  be  the  most 
prevalent  cause  of  misplacement  of  the  atlas.  Even  though 
we  recognize  the  numberless  jars,  twists  and  strains  of  this 
articulation,  still  the  resultant  bad  effects  are  maintained  by 
the  unequal  contraction  of  opposing  groups  of  muscles 
which  is  brought  on  by  these  accidents.  Take,  for  instance, 
the  various  twists  of  the  atlas  found  by  osteopathic  methods 
of  physical  diagnosis.  Gray  says :  "The  Recti  Laterales  are 
mainly  concerned  in  the  slight  lateral  movements."  This  is 
the  movement  concerned  in  a  lateral  subluxation.  The  po- 
sition in  which  we  usually  find  the  atlas  is  an  oblique  one, 
having  the  right  transverse  process  hugging  the  angle  of 
the  jaw  while  the  left  is  too  close  to  the  mastoid  process. 
Gerrish  describes  this  position  as  the  "obliquely  lateral,"  a 
normal,  movement.  We  also  consider  it  normal  if  it  pos- 
sesses the  ability  to  slip  back  into  a  position  having  similar 
relations  on  both  sides.  It  is  a  subluxation  when  it  can  not 
get  out  of  that  position  without  assistance.  If  there  is  free 
movement  in  the  occipito-atlantal  articulation,  every  change 
of  the  position  of  the  head  will  change  the  relations  in  this 
joint.  Our  bodies  are  constructed  so  that  when  the  bones, 
forming  a  joint,  are  moved  to  their  fullest  extent,  pressure 
is  usually  exerted  on  the  soft  tissues  around  the  joint.  This 
is  normal,  but  when  these  normal  relations  are  retained  too 
long  and  the  bones  do  not  resume  their  easy  resting  position 
the  condition  becomes  abnormal;  it  is  then  a  subluxated 
joint. 

There  is  no  articulation  in  the  body  whose  bony  parts 
are  abnormally  related  when  the  extreme  movement  in  the 
joint  is  made.  (We  will  except  the  sacro-iliac  articulation, 
because  it  is  not  ordinarily  considered  a  movable  joint.) 
The  subluxation  consists  in  the  relation  of  the  bony  sur- 


292  PRINCIPLES  OF  OSTEOPATHY 

faces  in  a  position  other  than  that  which  they  should  hold 
during  relaxation  or  equal  tension  of  all  the  muscles.  The 
normal  position  of  the  transverse  processes  of  the  atlas  is 
pictured  in  Fig.  102.  The  subluxations  are  pictured  in  Fig. 
103. 

Normal  Relations  of  the  Atlas. — The  normal  relations 
of  the  atlas  are  illustrated  by  photographs  of  the  skull  and 
first  vertebra  in  Fig.  104.  Fig.  105  shows  an  oblique  side 
view.  In  Fig.  106  the  atlas  is  slightly  twisted,  so  that  the 
right  transverse  process  is  posterior.  This  rear  view  shows 
the  distance  between  the  left  mastoid  and  left  transverse 
process  increased.  The  right  transverse  process  is  promi- 
nent. The  same  relations  viewed  from  below  are  shown  in 
Fig.  107.  The  right  transverse  process  is  slightly  posterior 
to  the  mastoid. 

Abnormal  Positions  of  the  Atlas. — Fig.  108  and  Fig.  109 
show  side  and  lateral  views  of  a  twisted  atlas.  In  preparing 
these  bones  for  photographing,  it  has  been  borne  in  mind 
that  the  articulating  surfaces  must  be  kept  in  close  apposi- 
tion. The  relations  illustrated  are  normal  to  the  articula- 
tion, but  abnormal  when  retained  in  these  positions  after  re- 
laxation of  opposing  muscles. 

The  Effect  of  Muscle  Contraction. — If,  as  Cruveilhier 
says,  there  is  a  slight  rotation  in  this  joint — and  osteopathic 
practice  proves  Cruveilhier's  statement  true — ,  then  what 
muscle  could  by  its  persistent  contraction  cause  this  rota- 
tion to  be  maintained?  The  Rectus  Capitis  Anticus  Minor  is 
so  placed  as  to  cause  this  movement.  It  arises  from  the  an- 
terior surface  of  the  lateral  mass  and  root  of  transverse  pro- 
cess of  the  atlas  and  passes  obliquely  upward  and  inward. 
It  is  inserted  into  the  basilar  process  of  the  occipital  bone. 
This  muscle  has  as  its  external  relation  the  superior  cervi- 
cal ganglion  of  the  sympathetic,  and  as  a  contracted  mus- 
cle is  thicker  than  an  uncontracted  one,  pressure  may  be 
exerted  on  this  ganglion  which  may  also  be  irritated  by  the 
transverse  process  of  the  atlas  being  pulled  toward  it,  there- 
by lessening  its  normal  space  in  more  than  one  direction. 


PRINCIPLES  OF  OSTEOPATHY  293 

The  reflexes  originated  by  this  irritation  of  the  superior 
cervical  ganglion,  or  its  connections,  may  initiate  changes 
in  the  caliber  of  the  blood  vessels  of  the  brain,  eyes  or  any 
other  circulatory  area  under  control  of  the  ganglion. 

The  Effect  on  Circulation. — The  influence  exerted  di- 
rectly on  circulation  by  the  subluxation  of  the  atlas  is  proba- 
bly most  active  where  the  vertebral  arteries  pass  through 
the  foramena  in  the  transverse  processes.  It  might  be  argued 
against  this  view  that  nature  has  not  failed  to  provide  a 
certain  amount  of  elasticity  in  the  artery  and  surrounding 
structures  to  meet  just  such  a  condition.  Nature  has  cer- 
tainly done  this,  but  not  with  the  idea  in  view  that  any  such 
exaggerated  condition  is  to  be  maintained  for  any  great 
length  of  time. 

Effect  on  Superior  Cervical  Ganglion. — Subluxations  of 
the  atlas  are  found  in  connection  with  a  great  number  of 
disturbed  areas,  but  the  condition  in  each  is  the  same.  For 
example,  there  is  no  difference  between  a  hyperaemia  in  the 
nasal,  pharyngeal  or  laryngeal  mucosa  and  a  congestion  of 
the  retina,  except  in  location.  We  must  not  view  the  phe- 
nomena of  retinitis  as  especially  different  from  those  of  lar- 
yngitis.' If  we  should  do  so,  we  fix  our  attention  on  symp- 
toms and  see  a  picture  which  conceals  causes.  When  the 
superior  cervical  ganglion  has  its  function  of  vaso-constric- 
tion  inhibited  by  continued  irritation,  the  work  of  main- 
taining vascular  tone  is  passed  along  to  peripherally  placed 
ganglia.  If  the  eyes  are  strained  by  overwork,  the  resistance 
of  their  nerves  is  decreased.  This,  added  to  the  weakened 
vaso-constrictor  action  of  the  superior  cervical  ganglia,  al- 
lows congestion,  a  retinitis.  Wearing  high  collars  weakens 
the  resistance  of  nerve  endings  in  the  skin  of  the  neck.  This, 
added  to  low  power  in  the  ganglionic  station,  leads  to  con- 
gestion in  the  pharynx  or  larynx.  Treatment  must  be  ap- 
plied to  the  structures  around  the  ganglion,  and  peripheral 
nerve  power  increased  by  gradually  exposing  the  skin  to 
the  atmosphere. 


294  PRINCIPLES  OF  OSTEOPATHY 

Atlo-axial  Articulation. — The  articulation  between  the 
atlas  and  axis  is  the  most  intricate  in  the  whole  spinal  col- 
umn, consisting  of  four  distinct  joints.  Rotation  takes  place 
between  these  bones,  but  this  motion  is  limited  by  the  check 
ligaments.  Dislocation  of  the  odontoid  process  causes  in- 
stant death  by  pressure  on  the  lower  part  of  the  medulla 
oblongata.  The  articulations  between  the  articular  pro- 
cesses of  these  bones  are  arthrodial.  The  articulation  be- 
tween the  odontoid  process  of  the  axis  and  anterior  arch  of 
the  atlas  holds  the  bones  firmly  together.  Most  of  the  rota- 
tion in  the  cervical  region  is  in  this  joint.  Although  there 
is  so  much  movement  allowed  by  these  articulations,  we  sel- 
dom find  the  axis  subluxated. 

Unequal  Development. — Deviation  of  the  spine  of  the 
axis  from  the  median  line  is  a  frequent  condition,  but  in  the 
majority  of  cases  is  its  normal  relation  on  account  of  un- 
even development. 

Caries. —  Hilton  describes  cases  of  disease  of  the  articula- 
tion between  the  atlas  and  axis,  showing  how  destruction  of 
the  transverse  ligaments  allows  the  head  to  tip  forward, 
thereby  causing  the  odontoid  process  to  impale  the  medulla. 

Dislocation. — \Ye  may  safely  say  that  dislocation  of  the 
atlo-axial  articulations  is  probably  the  rarest  condition  we 
will  ever  meet.  Various  degrees  of  rotation  may  be  met 
with  which  are  in  the  nature  of  subluxations  due  to  muscular 
contractions. 

Spontaneous  Reduction. — Since  the  above  paragraph 
was  written,  an  article  in  the  Medical  Record,  March  3, 
1()00,  has  come  under  my  observation.  The  article  is  en- 
titled "Spinal  Fracture — Paraplegia."  The  author,  Dr.  Rob- 
ert Abbe,  exhibits  a  radiograph  illustrating  a  case  of  dislo- 
cation of  the  neck.  The  dislocation  is  between  the  articular 
processes  of  the  atlas  and  axis.  The  most  interesting  feature 
of  the  case  is  the  spontaneous  reduction  of  the  dislocation 
while  the  patient  was  asleep.  The  author  thinks  that  the 
relaxation  of  sleep  and  the  restlessness  of  the  patient  com- 
bined to  reduce  it. 


PRINCIPLES  OF  OSTEOPATHY 


295 


Cervical  Vertebrae. — The  remaining  cervical  vertebrae 
are  occasionally  forced  from  their  proper  relations  by  vio- 
lence. Quite  a  number  of  cases  are  on  record  which  show 
how  great  the  disturbance  is  in  such  conditions.  Those 
cases  recorded  in  medical  literature  are  complete  disloca- 


FIG.  110.  Normal  rela- 
tions ot  the  cervical 
vertebrae. 


FIG.  111.  Third  cervical 
vertebra  subluxated  to 
the  right.  The  superior 
articular  process  of  the 
fourth  cervical  is  vis- 
ible. 


tions,  and  hence  can  not  be  classed  with  subluxations  such 
as  are  met  with  in  osteopathic  practice.  In  order  for  com- 
plete dislocation  to  take  place,  i.  e.,  so  that  the  articular  pro- 
cesses are  both  locked,  the  intervertebral  disks  would  have 
to  be  torn  and  would  probably  bring  great  pressure  on  the 
cord. 

All  grades  of  subluxation  are  found  between  cervical 
vertebrae.  Where  the  violence  has  not  been  sufficient  to 
cause  locking  of  the  articular  processes,  it  has  exaggerated 
the  normal  movement  sufficiently  to  injure  the  ligaments 
or  muscles,  which  therefore  maintain  the  subluxated  posi- 
tion. 

Disproportion  Between  Cause  and  Effect. — We  cannot 
estimate  the  extent  of  the  systemic  effects  of  a  lesion  in  the 


296  PRINCIPLES  OF  OSTEOPATHY 

spine.  What  might  appear  to  us  to  be  a  very  slight  lesion 
might  l^e  the  cause  of  a  very  profound  nervous  disorder. 
The  position  of  the  lesion  is  the  chief  means  of  estimating 
results. 

Example. — To  illustrate  this  point,  we  may  mention  the 
case  of  Mr.  Norton  Russell.  A  lesion  of  the  sixth  cervical 
vertebra  was  found.  The  vertebra  was  slightly  twisted. 
Mr.  Russell  had  not  slept  during  one  hundred  nights  ana 
days  without  the  use  of  sulphonol  or  morphine.  The  fiist 
osteopathic  treatment  applied  to  the  sixth  cervical  vertebra 
made  it  difficult  for  him  to  keep  awake  until  he  reached  his 
home  and  then  he  fell  into  a  profound  sleep.  There  was  a 
history  of  severe  accident.  Muscular  contraction  was  very 
evident. 

Unequal  Development  of  Spinous  Processes  in  Cervical 
Vertebrae. — Fig.  110  illustrates  the  appearance  of  the  poster- 
ior surfaces  of  the  cervical  vertebrae,  second  to  the  seventh, 
when  all  the  vertebrae  are  in  normal  position,  i.  e.,  articular 
surfaces  evenly  opposed  to  each  other.  The  changing  char- 
acter of  the  spinous  processes  is  readily  noted.  Nearly  all 
of  these  processes  are  unevenly  developed,  showing  that  pal- 
pation of  these  prominent  points  can  not  help  being  unsatis- 
factory. The  tubercles  on  the  back  and  outer  surfaces  of  the 
inferior  articular  processes  present  a  much  more  uniform 
development  and  they  can  be  easily  palpated  after  one  has 
become  accustomed  to  the  feel  of  the  cervical  muscles.  Fig. 
Ill  shows  the  third  cervical  subluxated  to  the  right.  The  tu- 
bercle on  the  left  inferior  articular  process  is  made  more 
prominent.  The  muscles  over  this  point  will  be  found  con- 
tracted. 

Palpation  of  Dorsal  Spinous  Processes. — When  the 
spines  of  the  dorsal  vertebrae  are  palpated,  the  trained 
fingers  may  find  individual  spines  which  are  not  in  line  with 
those  above  and  below,  or  that  the  spacings  between  the 
spines  are  not  equal.  The  deviations  from  the  normal  are 
indicative  of  changed  relations  between  the  vertebrae. 


PRINCIPLES  OF  OSTEOPATHY 


297 


Normal  Dorsal  Movements. — The  normal  movements 
in  the  dorsal  region  are  flexion,  extension  and  rotation.  The 
lesions  in  this  region  correspond  with  these  movements. 

False  Lesions. — We  must  guard  against  being  misled  by 
the  deviations  which  we  find,  especially  lateral  ones.  Fig. 
112  illustrates  a  decided  lateral  inclination  of  the  third  dorsal 


FIG.  112.  Abnormal  development 
of  the  spinous  process  of  the 
third  dorsal  vertebra.  A  false 
lesion. 


FIG.  113.  Lateral  sub- 
luxation  of  a  dorsal 
vertebra. 


FIG.  114.  Flexion  in  the 
dorsal  region  showing 
spinous  processes  sepa- 
rated and  superior  ar- 
ticular processes  par- 
tially uncovered. 


FIG.  115.    Lateral  view  of  same 
condition  as  Fig.  114. 


298 


PRINCIPLES  OF  OSTEOPATHY 


spiiums  process.  Such  a  deflection  from  the  median  line 
would  be  noted  by  the  unskilled  touch  of  a  layman.  This 
deflection  has  no  diagnostic  significance,  unless  there  is  pro- 
nounced sensitiveness  around  it,  and  then  it  is  the  hyperaes- 
thesia  and  not  the  osseous  formation  that  must  be  noted.  A 


FIG.  116.  Extension  in  the 
dorsal  region  showing  ap- 
proximation of  the  spinous 
processes. 


very  skillful  osteopathic  diagnostician  might  be  misled  by 
this  lesion.  There  does  not  appear  to  be  any  way  to  pro- 
tect against  a  wrong  interpretation  in  a  case  like  this  except 
the  experience  of  the  physician  in  weighing  all  the  evidence. 

Lateral  Subluxation. — Fig.  113  illustrates  a  genuine  lat- 
eral subluxation  of  a  dorsal  vertebra.  The  arrangement  of 
the  Rotatores  Spinae  account  for  such  a  lesion  as  this.  They 
arise  from  the  upper  surfaces  of  the  transverse  processes  and 
insert  .into  the  laminae  above.  The  subluxated  vertebra  in 
this  group  is  the  fifth.  The  digitation  of  the  Rotatores 
Spinae  between  the  right  transverse  process  of  the  sixth  and 
lamina  of  the  fifth  must  contract  in  order  to  produce  this 
condition.  This  digitation  may  respond  to  a  severe  visceral 
reflex  and  cause  a  subluxation  of  this  character.  Direct 
violence  may  cause  it,  also  a  cutaneous  reflex  initiated  by 
temperature  change  in  the  atmosphere. 


PRINCIPLES  OF  OSTEOPATHY  299 

Muscular  Contraction. — Muscles  contract  as  a  result  of 
excessive  straining-  or  wrenching,  or  exposure  to  cold  and 
of  reflex  irritation.  If  opposing  muscles  under  all  condi- 
tions of  temperature,  mechanical  and  reflex  irritation  would 
continue  to  exert  equal  influence  on  a  joint,  then  nothing 
but  a  complete  dislocation  would  be  possible.  A  movable 
joint  is  enclosed  in  a  synovial  membrane  which  facilitates 
the  rapid  return  to  a  normal  position.  All  the  mechanical 
conditions  in  and  around  a  joint  are  conducive  to  the  quick 
return  to  normal.  It  is  the  vital  and  not  the  mechanical 
principle  which  keeps  up  a  condition  of  maladjustment.  No 
intermediate  position  is  possible,  there  being  no  unevenness 
of  surface  to  become  locked,  unless  we  take  into  considera- 
tion the  vital  activity  as  manifested  in  a  contracted  muscle. 

Comparison  of  Effects  of  Muscular  Contraction. — J.  E. 
Stuart,  D.  O.,  has  made  an  apt  comparison  between  the  pull 
of  the  muscles  of  the  back  on  the  individual  vertebrae  and 
the  well  recognized  insufficiencies  of  the  ocular  muscles.  All 
physicians  recognize  the  serious  effects  of  long  continued 
insufficiency  of  an  ocular  muscle,  but  few,  indeed,  have  given 
any  thought  to  the  possibility  of  a  similar  condition  affect- 
ing structures  less  movable,  or  less  sensitive,  than  the  eye- 
ball. The  relation  of  a  vertebra  with  its  fellows  is  of  great 
importance  to  the  delicate  nervous  tissue  which  it  sur- 
rounds. It  is  not  necessary  for  a  vertebra  to  press  upon  the 
spinal  cord,  or  nerve  fibers  coming  from  or  going  to  it,  in 
order  to  produce  irritation.  There  is  a  nerve  strain  in  con- 
nection with  these  lesions  which  is  not  the  result  of  direct 
pressure  but  of  the  efforts  of  the  central  nervous  system  to 
balance  and  coordinate  the  contraction  of  the  muscles  pull- 
ing on  the  vertebra.  It  is  not  necessary  for  divergent  or 
convergent  squint  to  be  so  marked  that  the  expression  of 
-the  eyes  is  instantly  noted  by  all  observers  before  any  symp- 
toms of  eye  strain  are  felt  by  the  patient.  Neither  is  it  neces- 
sary for  a  vertebra  to  be  dislocated  in  order  to  create  a  dis- 
turbance. It  is  conceivable  that  a  completely  dislocated 
vertebra  might,  after  a  time,  cause  as  little  irritation  as  an 


300  PRINCIPLES  OF  OSTEOPATHY 

eyeball  which  is  so  divergent  that  no  effort  is  made  to  use 
binocular  vision.  The  body  becomes  accommodated  to  the 
change. 

Separation  of  Spinous  Processes. — Figs.  114  and  115  give 
two  views  of  the  fifth,  sixth  and  seventh  vertebrae,  illustrat- 
ing the  separation  of  the  spines,  as  in  extreme  flexion.  Note 
that  the  superior  articular  facets  are  uncovered  by  the  move- 
ment. The  vertebrae  assume  this  position  in  kyphosis.  We 
frequently  find  that  there  is  a  gap  between  two  spines  while 
the  spacing  above  and  below  is  quite  even.  Either  the  space 
directly  above  or  that  below  this  gap  is  lessened.  Fig.  116 
shows  the  spine  of  the  fifth,  sixth  and  seventh  dorsal  verte- 
brae in  the  position  of  extreme  extension.  The  spines  crowd 
hard  upon  each  other.  These  illustrations  all  show  normal 
positions,  but  they  are  the  ones  which  our  fingers  discover 
as  lesions  of  the  vertebrae. 

Approximation  of  Spinous  Processes. — When  two  spines 
are  closely  approximated,  as  in  Fig.  116.  there  is  neces- 
sarily a  widening  of  the  next  space  above  or  below,  depend- 
ing upon  which  vertebra  is  affected.  The  contracted  space 
will  usually  be  sensitive  to  digital  pressure.  There  is  a  con- 
tractured  condition  of  the  muscles  causing  this  extreme 
movement  of  extension.  This  contracture  disturbs  the 
rhythm  of  nerve  impulses  from  that  section  of  the  spinal 
cord  in  closest  relation  with  the  disturbed  vertebra.  There 
is  lack  of  coordination  of  movement  in  the  affected  joints. 
When  several  vertebrae  are  tightly  bound  together  a 
straight,  non-flexible  spinal  column  is  the  result.  The  mus- 
cles are  tightly  contracted  and  more  or  less  sensitive  to  digi- 
tal pressure. 

Primary  Subluxations. — These  conditions,  as  here  illus- 
trated, are  what  osteopaths  usually  designate  as  spinal  sub- 
luxations  which  are  causative  factors  in  disease.  They  are 
sources  of  irritation  to  the  spinal  nerves  in  direct  central 
relation  with  them,  and  these  nerves  convey  disturbed  or 
arythmical  impulses  to  the  viscera  and  blood  vessels,  thus 


PRINCIPLES  OF  OSTEOPATHY 


301 


causing  the  various  perversions  of  function  which  are  recog- 
nized as  symptoms  of  disease. 

Secondary  Subluxations. — These  lesions  must  also  be 
recognized  as  structural  changes  resulting  from  excessive 
irritation  to  the  peripheral  end  of  seVisory  nerves,  either 
those  ending  in  skin  and  subject  to  the  temperature  changes 
or  those  ending  in  the  visceral  muscosa  and  subject  to  irrita- 
tion from  the  presence  of  food  of  an  indigestible  character, 
products  of  fermentation,  etc.  We  must  recognize  the  fact 
that  sensory  nerves  are  subject  to  excessive  stimulation  in 
cases  of  gluttony  or  masturbation.  Both  of  these  bad  habits 
may  result  from  the  stimulation  of  a  spinal  lesion,  but  ex- 
perience with  humanity  teaches  the  physician  that  mankind 
in  general  delights  in  gratifying  the  senses.  We  do  not  wish 
to  place  spinal  lesions  at  the  bottom  of  man's  moral  weak- 
nesses. 

Limited  Area  for  Lateral  Subluxations. — Lateral  sub- 
luxations  may  exist  as  low  as  the  tenth  dorsal  spine.  The 
articular  processes  of  the  eleventh  and  twelfth  dorsal 


FIG.  117.— Posterior  view  of  five 
lower  dorsal  vertebrae,  nor- 
mal relations. 


FIG.  118.  Side  view  of  five 
lower  dorsal  vertebrae, 
normal  relations. 


302  PRINCIPLES  OF  OSTEOPATHY 

vertebrae  take  on  the  character  of  the  lumbar,  hence  rota- 
tion is  practically  impossible.  There  is  a  (limitation  of  the 
Rotatores  Spinae  between  the  eleventh  and  twelfth  dorsal 
vertebrae. 

Lower  Dorsal  Vertebrae. —  Figs.  117  and  118  give  a  pos- 
terior and  lateral  view  of  the  five  lower  dorsal  vertebrae. 
The  changing  characteristics  of  the  spinous  processes  of 
these  vertebrae  should  be  carefully  noted,  so  that  the  stu- 
dent may  not  be  misled  as  to  the  significance  of  that  which 
his  palpation  may  discover.  The  eleventh  dorsal  spine  takes 
a  horizontal  direction,  and  in  some  cases  this  makes  either 
a  very  narrow  space  between  it  and  the  tenth  or  a  very  wide 
space  between  it  and  the  twelfth. 

Dorso-Lumbar  Articulation. — The  junction  of  the  dor- 
sal and  lumbar  regions  is  very  flexible.  A  large  portion  of 
flexion  and  extension  of  the  spinal  column  is  made  in  this 
articulation.  The  most  common  condition  noticeable  in  the 
lower  dorsal  region  is  increased  prominence  of  the  spines, 
and  incipient  kyphosis.  This  condition  frequently  affects 
the  junction  of  the  dorsal  and  lumbar  regions. 

Kyphosis — Lower  Dorsal. — A  slight  kyphosis  in  the 
lower  dorsal  region  is  indicative  of  loss  of  tone  in  the  exten- 
sor muscles  governing  the  articular  surfaces.  The  spines 
are  separated  farther  than  normal  and  the  inferior  articulat- 
ing surfaces  are  partly  uncovered  by  the  superior  ones. 
This  weakened  condition  of  the  back  may  be  brought  on 
by  injury,  or  reflexes  from  the  bowels  or  kidneys.  Contin- 
ual vibration  of  the  spinal  column,  as  in  cases  of  street  car 
men,  weaken  the  back  and  then  functional  disturbances  of 
the  kidneys  are  noted. 

Lumbar  Region.— Figs.  119  and  120  illustrate  the  lateral 
and  posterior  appearance  of  the  normal  lumbar  vertebrae. 
The  spinous  processes  are  easily  palpated  in  this  region. 
Their  development  varies  enormously  in  different  individ- 
uals. The  formation  of  the  articular  processes  prevents 


PRINCIPLES  OF  OSTEOPATHY 


303 


any  rotation,  hence  we  do  not  find  any  lateral  subluxations 
in  this  region.  The  position  of  individual  vertebrae  is  rare- 
ly affected.  "Breaks,"  that  is,  separations  of  the  spines, 
are  sometimes  noted,  but  not  often.  Violence  is  the  chief 
cause 'of  these  separations.  The  muscles  in  this  region  are 


FIG.      120.     Lumbar 
rear  view — normal. 


region, 


FIG.    119. — Lumbar   region, 
—normal. 


Side   view 


thick  and  powerful,  hence  their  influence  is  not  exerted  so 
much  on  individual  vertebrae  as  upon  the  whole  series  of 
vertebrae.  Therefore  we  find  curves  instead  of  subluxations 
in  this  region.  Exaggeration  of  the  normal  movements  is 
responsible  for  kyphosis,  lordosis  or  scoliosis.  Extreme 
weariness,  as  a  result  of  maintaining  a  sitting  or  standing 
position,  leads  the  individual  to  shift  the  weight  of  the  body 
so  as  to  take  some  advantage  of  the  ligaments  which  limit  a 
movement.  The  strength  and  flexibility  of  the  lumbar 
region  is  frequently  a  very  good  criterion  of  the  patient's 
bodily  vigor.  It  is  easier  to  affect  this  portion  of  the  spinal 
column,  by  leverage  movements,  than  any  other  region. 


304  PRINCIPLES  OF  OSTEOPATHY 

Examination  of  the  Ribs. — The  position  of  the  ribs  is  al- 
ways noted  by  the  osteopathic  physician.  It  is  noted,  in 
medical  text-books  on  diagnosis,  that  the  general  conforma- 
tion of  the  thorax  is  indicative,  to  a  variable  degree,  of  either 
the  past  medical  history  of  the  individual  or  is  evidence  of 
the  present  existence  of  predisposition  to  certain  diseases. 
A  full,  round,  nonrlexible  chest  denotes  asthma  or  emphy- 
sema ;  Hat  chest  denotes  tendency  to  tuberculosis,  etc.  These 
statements  are  generalizations  based  on  long  observation, 
and  are  usually  very  near  the  truth.  The  respiratory  move- 
ments should  be  noted,  whether  full  and  free,  compared 
with  the  capacity  of  the  thorax.  The  osteopathic  physician 
goes  farther  than  these  excellent  generalizations  in  his  diag- 
nosis. The  relation  and  position  of  each  individual  rib  are 
extremely  important.  The  condition  of  the  whole  thorax 
and  its  contents  is  dependent  on  the  relations  of  the  bones 
which  form  it.  \Yith  this  idea  in  mind,  a  careful  examina- 
tion of  each  rib  is  made. 

The  ribs  are,  normally,  quite  movable.  Their  spinal 
articulations  are  so  arranged  that  an  easy  rise  and  fall  of  the 
shaft  of  the  rib  is  permitted.  The  rise  and  fall  is  the  result 
of  rotation  of  the  rib  on  an  axis  passing  through  the  costo- 
central  and  costo-transverse  articulations. 

Costo-central  Articulations. — The  costo-central  articu- 
lations of  the  first,  tenth,  eleventh  and  twelfth  ribs  have  no 
interarticular  ligament.  The  movement  of  the  heads  of  these 
ribs  is  limited  by  the  capsular  ligaments.  The  heads  of  all 
the  other  ribs  are  held  in  place  by  interarticular  ligaments 
attached  to  ridges  on  the  heads  of  the  ribs  and  to  the  inter- 
vertebral  disks. 

Costo-transverse  Articulations. — The  tubercles  of  the 
ribs  articulate  with  the  transverse  processes  of  the  verte- 
brae forming  arthrodial  joints.  The  superior  costo-trans- 
verse ligaments  prevent  the  dropping  down  of  the  costo- 
transverse  articulation.  There  is  very  limited  gliding  move- 
ment in  this  articulation.  As  before  stated,  the  movement 
in  the  costo-central  and  costo-transverse  articulations  is  ro- 


PRINCIPLES  OF  OSTEOPATHY 


305 


tary.  The  shaft  of  the  rib  lies  obliquely  downward,  there- 
fore the  rotation  of  the  rib  during  inspiration  turns  the  an- 
terior extremity  upward  and  outward.  The  axis  of  the  rota- 
tion through  the  costo-vertebral  articulations  is  obliquely 
downward,  therefore  the  lateral  position  of  the  shaft  of  the 
rib  is  elevated  during  inspiration  and  the  lower  border  is 
turned  outward. 


FIG.     121.     Normal     relations 
fifth  and  sixth  ribs. 


of     the 


FIG.    122.     Approximation   of  the   fifth 
and  sixth  ribs. 


306  PRINCIPLES  OF  OSTEOPATHY 

Coordination. —  Fig.  121  illustrates  the  normal  obliquity 
of  the  fifth  and  sixth  ribs.  When  the  contraction  of  all  the 
muscles  of  respiration  is  properly  coordinated,  the  inter- 
costal spaces  are  all  equal  in  width.  The  respiratory  rhythm 
should  be  equal  in  all  parts  of  the  thorax. 


FIG.    123.     Separation  of   the   fifth  and 
sixth    ribs. 


Incoordination. — \Yhcn  through  some  nervous  reflex 
inspiration  is  made  difficult,  the  inspiratory  muscles  expand 
the  thorax  to  its  fullest  extent  and  retain  the  expansion. 
Then  the  diameters  of  the  thorax  are  increased.  This  posi- 
tion of  extreme  inspiration  is  typical  of  the  asthmatic  chest. 
There  may  be  lack  of  coordination  of  the  muscles  in  any 
intercostal  space.  This  incoordination  may  be  manifested 
by  too  much  contraction  or  relaxation.  The  result  is  a 
change  in  the  normal  width  of  an  intercostal  space. 

Nervous  Control  of  Respiration. — Respiration  is  car- 
ried on  by  a  complicated  mechanism.  Its  chief  center  of  nor- 
mal control  is  in  the  medulla,  but  subsidiary  centers,  in  lin- 
ear series,  exist  in  the  spinal  cord.  Each  spinal  nerve  which 
innervates  intercostal  muscles,  or  other  muscles  of  inspira- 
tion, arises  from  a  subsidiary  respiratory  center.  One  of 
these  subsidiary  centers  may  become  too  active  or  passive 
as  a  result  of  local  irritation,  due  to  circulatory  changes. 


307 

The  muscles  governed  by  this  disturbed  center  will  not  act 
harmoniously,  hence  the  rhythmical  movement  of  all  the 
ribs  is  interfered  with. 

We  have  noted  that  spinal  muscles  contract  unevenly 
as  a  result  of  direct  spinal  injury,  exposure  of  the  skin  over 
them  to  cold,  or  from  visceral  reflexes.  The  respiratory 
muscles  are  subjected  to  the  same  conditions.  A  lateral  sub- 
luxation  in  the  dorsal  region  carries  its  articulated  rib  with 
it.  Palpation  will  discover  their  changed  relations.  A  ky- 
phosis  in  the  dorsal  region  causes  the  ribs  to  rotate  upwards, 
thus  increasing  the  diameters  of  the  thorax.  Lordosis  in 
this  region  has  the  opposite  effect. 

Costal  Subluxations. — Figs.  122  and  123  illustrate  the 
changes  in  spacing  of  the  ribs  due  to  incoordination  of  mus- 
cular contraction.  These  positions  of  the  ribs  are  spoken  of 
as  costal  subluxation.  In  Fig.  122  the  upper  rib  is  rotated 
downward  as  a  result  of  a  contraction  of  the  intercostal 
muscles  in  the  space  below  it,  or  the  relaxation  of  those 
above  it.  Palpation  elicits  sensitiveness  at  the  lower  border 
of  this  fifth  rib.  The  sensitiveness  is  usually  found  where 
there  is  compression  due  to  the  dropping  of  the  rib  and  the 
contraction  of  the  muscles.  This  rib  might  have  become 
displaced  as  a  result  of  violence,  or  the  patient  might  have 
been  exposed  to  cold  air  while  sweaty,  or  some  disease  of 
another  part  of  the  body  might  have  caused  sufficient  weak- 
ness to  allow  this  rib  to  drop  as  a  result  of  pressure  occa- 
sioned by  the  position  in  bed  or  otherwise. 

Whatever  the  cause  of  these  subluxations,  they  certain- 
ly become  sources  of  great  irritation  to  the  nervous  system. 
Sometimes  the  body  becomes  accommodated  to  these  sub- 
luxations,  but  the  fact  that  cases  of  asthma  have  been  cured 
after  years  of  suffering,  by  reducing  these  malpositions,  is 
prima  facie  evidence  that  accommodation  is  something  that 
can  not  always  be  depended  on. 

The  heads  of  the  second  to  ninth  ribs  cannot  be  dislo- 
cated without  rupture  of  the  interarticular  ligaments.  Con- 


308  PRINCIPLES  OF  OSTEOPATHY 

siderablc  change  in  the  position  of  the  shaft  of  the  rib  occa- 
sions very  little  change  in  the  position  of  the  head  of  the 
rib. 

First  Rib. — The  first  rib  does  not  move  in  the  same 
manner  as  those  below.  The  attachment  of  the  scalenus  an- 
ticus  keeps  the  shaft  always  raised.  No  matter  how  flat  the 
remainder  of  the  thorax  may  be,  the  first  rib  stands  out 
prominently.  The  chief  change  in  its  position  is  due  to  the 
contraction  of  the  scalenus  anticus,  therefore  it  needs  to  be 
depressed  rather  than  elevated. 

Tenth  Rib. — The  head  of  the  tenth  rib  is  articulated 
with  the  body  of  the  tenth  vertebra;  there  is  no  interarticu- 
lar  ligament.  This  allows  freer  movement.  Its  anterior 
extremity  is  insecurely  articulated  to  the  cartilage  of  the 
ninth  rib.  This  connection  is  frequently  broken,  thus  mak- 
ing an  added  floating  rib. 

Eleventh  and  Twelfth  Ribs. — The  eleventh  and  twelfth 
ribs  are  very  loosely  articulated  to  the  vertebrae.  They 
have  no  costo-transverse  ligaments,  hence  depend  on  the  ac- 
tion of  muscles  to  hold  them  in  place.  They  are  frequently 
found  rotated  upward  or  downward. 

\Ye  have  endeavored  to  show  that  the  normal  move- 
ments of  the  ribs,  as  a  whole,  may  become  very  abnormal 
when  made  individually,  or  out  of  rhythm  with  each  other. 
The  depressions  or  elevations  of  individual  ribs  have  not  dis- 
located their  articulations ;  they  have  merely  carried  and  re- 
tained them  in  positions  out  of  harmnoy  with  the  remainder 
of  the  ribs.  They  have  become  discordant  members  of  a 
harmonious  body,  and  unless  made  to  cooperate  for  the  gen- 
eral welfare,  they  will  rapidly  make  other  members  inhar- 
monious. 

Effect  of  Position  of  Vertebrae  on  Position  of  Ribs. — 
Lack  of  symmetry  in  the  dorsal  vertebrae  causes  a  change  in 
the  position  of  the  ribs.  Both  conditions  can  be  corrected 
by  reduction  of  the  vertebral  subluxations. 


PRINCIPLES  OF  OSTEOPATHY 


309 


FIG.  124.  Traumatic  lesion  of 
right  sterno-clavicular  articula- 
tion, followed  by  enlargement  of 
right  lobe  of  the  thyroid  gland. 


The  Clavicles. — The  clavicles  may  be  elevated  or  de- 
pressed by  muscular  contraction.  Their  depression  affects 
the  vessels  crossing  the  first  rib  and  from  the  upper  ex- 
tremity. The  subclavius  is  responsible  for  the  depression 
of  the  clavicle. 

Summary. — Every  individual  has  his  or  her  particular 
development.  When,  examining  patients  this  must  be  taken 
into  consideration.  All  subluxations  must  be  judged  accord- 
ing to  the  condition  of  the  reflexes  along  the  nerve  tracts 
which  they  might  influence. 

A  subluxation  is  evidence  of  unequal  activity  of  oppos- 
ing muscles,  caused  by  twist,  strain,  fall,  thermal  change  or 
reflex  irritation  from  viscera.  It  is  an  evidence  of  vital  ac- 
tivity unevenly  manifested.  The  mechanical  condition 


310  PRINCIPLES  OF  OSTEOPATHY 

which  we  call  a  lesion,  may  be  only  evidence  of  a  lesion 
which  lies  in  the  excessively  active  muscle  or  at  some  other 
point  in  close  nervous  connection. 

A  subluxation  may  be  called  a  primary  lesion  when  it 
results  from  accident.  It  is  secondary  when  due  to  reflex 
action.  It  is  not  always  possible  to  determine  whether  a 
lesion  is  primary  or  secondary,  but  in  general  it  is  best  to 
reduce  them  wherever  found,  if  any  disturbance  can  be 
traced  to  them. 

In  rare  instances  one  treatment  has  been  found  suffi- 
cient to  reduce  a  subluxation.  The  fact  that  the  majority  of 
cases  must  be  treated  two  or  three  months  proves  that  they 
are  not  easily  kept  reduced. 


PRINCIPLES'  OF  OSTEOPATHY  311 


CHAPTER  XV. 

THE  DIAGNOSTIC  VALUE  OF  BACKACHE. 

Elasticity. — It  is  frequently  said  that  "a  man  is  as  old 
as  his  arteries."  It  may  with  equal  significance  be  said  that 
a  man  is  as  old  as  his  spinal  column.  In  either  case  a  loss  of 
elasticity  lessens  one's  youthfulness  out  of  all  proportion  to 
one's  actual  years. 

A  Field  for  Study. — The  use  of  the  back  and  the  spinal 
column  as  a  field  for  initiating  an  effort  to  diagnose  the 
physical  condition  of  human  beings,  has  many  advantages, 
both  for  eliciting  objective  and  subjective  information. 
Probably  few  physicians  realize  how  much  of  physical  dis- 
tress is  mirrored  in  symptoms  consciously  or  unconsciously 
referred  to  the  back. 

Objective  and  Subjective  Symptoms. — In  order  that  we 
may  have  something  for  reference  we  will  pass  a  few  facts 
in  review.  As  diagnosticians  we  are  always  desirous  of 
knowing  whether  the  structure  of  the  back  is  normal  and 
whether  there  is  any  distress,  i.  e.,  pain  of  any  character,  in 
the  tissues  of  the  back.  Here  we  have  the  old  division  of 
objective  and  subjective  symptoms. 

Pain. — Pain  is  the  symptom  which  usually  leads  a  pa- 
tient to  seek  relief  or  advice,  hence  we  are  interested  in  seek- 
ing the  cause  of  the  pain.  The  simplest  possible  cause  of 
the  pain  should  naturally  be  the  first  thing  considered.  Since 
many  localized  peripheral  and  visceral  pains  either  are 
caused  by  conditions  in  the  structures  of  the  back,  or  at  least 
reflexly  produce  areas  of  associated  hyperaesthesia  there,  we 
seek  to  discover  what  structural  fault  or  referred  sensitive- 
ness may  exist. 


312  PRINCIPLES  OF  OSTEOPATHY 

Poise. — The  first  observation  should  be  addressed  to  de- 
termining the  poise  of  the  body,  i.  e.,  statics.  It  is  very  im- 
portant to  note  the  poise  of  the  body.  There  are  many  dev- 
iations from  normal  which  arc  only  slightly  apparent  but 
nevertheless  give  rise  to  bodily  distress.  Postural  faults  in 
adults  lead  to  distress  due  to  fatigue  of  the  tissues  and,  as 
the  bones  are  not  plastic,  pain  is  felt.  The  child's  bones  are 
plastic,  hence  the  same  force  that  produces  distress  in  ma- 
ture persons  causes  structural  distortion  in  children,  i.  e., 
the  static  conditions  which  in  children  produce  spinal  de- 
formitv  produce  in  mature  persons  spinal  distress. 

Structural  Defects. —  I'ain  in  the  back  is  of  such  fre- 
quent occurrence  that  it  is  advisable  for  us  to  consider  some 
of  the  general  and  special  conditions  which  may  be  more  or 
less  characterized  bv  backache.  Since  we  are  exponents  of 
a  system  of  corrective  manipulation  we  naturally  look  first 
for  possible  structural  defects.  The  simplest  structural  de- 
fect would  be  a  bad  posture  with  its  consequent  imbalance 
in  the  muscle  groups  which  maintain  the  body  erect. 

Statics.--!.  Statics.  Under  this  head  we  must  consider 
backache  as  a  possible  result  of  any  change  in  structural  sup- 
port. The  muscles  of  the  back  must  compensate,  by  altered 
tension,  for  any  change  in  the  length  of  a  leg,  such  as  that 
present  in  Hat-foot,  slightly  Hexed  knee,  knock-knee,  or  a  sa- 
cro-iliac  lesion.  The  pain  due  to  flat-foot  is  one  of  the  most 
common  complaints.  Many  cases  of  so-called  "innominate 
lesions"  are  nothing  more  than  backache  caused  by  the  ef- 
fort to  compensate  for  a  weak  arch.  Manipulation  of  the 
muscles  of  the  back  gives  relief  but  does  not  remove  the 
cause.  The  longer  such  a  condition  exists,  i.  e.,  flat-foot,  the 
more  widespread  will  be  the  back  pains.  Segments  above 
the  lumbar  are  gradually  involved  until  it  is  hard  to  recog- 
nize where  the  vicious  cycle  began.  Backache  due  to  dis- 
turbed statics  is  a  fatigue  pain,  i.  e..  is  evidence  of  tired  mus- 
cles or  strained  ligaments.  All  such  backaches  are  relieved 
by  manipulation.  They  disappear  under  the  influence  of 
tonic  exercise,  such  as  mountain  climbing,  because  the  un- 


PRINCIPLES  OF  OSTEOPATHY 


313 


FIG.  125.  Right  dorsal-left  lumbar 
lateral  curvature.  Note  the  out- 
line of  the  body. 


314  PRINCIPLES  OF  OSTEOPATHY 

evenness  of  the  ground  necessitates  constant  variation  in 
muscular  tension.  \Yalking  on  pavement  rapidly  produces 
fatigue,  because  each  movement  is  a  replica  of  the  preceding 
one. 

General  Debility. — General  debility  may  lead  to  static 
errors  with  consequent  distress.  Many  static  errors  make 
their  appearance  during  a  slow  convalescence  and  then  per- 


FIG.  126.  Position  which  shows,  by 
tho  outlines  of  the  vertebral  bor- 
ders of  the  scapulae,  that  rota- 
tion of  the  vertebral  bodies  ex- 
ists as  high  as  the  sixth  dorsal. 


PRINCIPLES  OF  OSTEOPATHY 


315 


FIG.  127.  Correction  of  the  lum- 
bar cucve  by  raising  the  left 
buttock. 


316 


PRINCIPLES  OF  OSTEOPATHY 


sist  in  spite  of  improved  muscle  tone ;  in  fact  are  never  rec- 
ognized until  such  time  as  they  force  special  attention  be- 
cause of  the  distress  they  cause. 

Sacro-iliac  Subluxation.— Since  backache  is  one  of  the 
most  prominent   symptoms  in  cases  of  sacro-iliac  subluxa- 


FIG.  12!S.  The  effect  of  rotation  of 
the  bodies  of  the  vertebrae,  in 
spinal  curvature,  on  the  location 
and  extent  of  side  bending. 


FIG.    129.     Same    case    bending    to 
the    left. 


tion,  no  examination  would  be  complete  without  taking  the 
possibility  of  such  a  lesion  under  consideration. 

Spinal  Rotation. — Practically  all  static  conditions  of 
long  standing  are  characterized  by  slight  spinal  rotation. 
This  is  the  natural  result  of  the  body's  effort  to  transmit  its 
weight  through  its  strongest  side.  This  compensatory  rota- 
tion can  not  be  corrected  without  taking  into  consideration 
that  condition  for  which  the  rotation  is  itself  a  correction. 


PRINCIPLES  OF  OSTEOPATHY 


317 


FIG.  130.  This  picture  shows  that 
the  lumbar  curve  is  primary  and 
clue  to  faulty  development  of  the 
left  lower  extremity. 


FIG.  131.  Correction  of  the  lateral 
Inrnhar  curve  bv  lengthening  the 
left  leg. 


318 


PRINCIPLES  OF  OSTEOPATHY 


Spinal  Curvature. — Curvature  of  the  spinal  column  is 
not  always  characterized  by  local  or  general  backache.  As 
a  general  rule  structural  scolicses  are  not  painful.  This  is 
probably  because  the  shape  of  the  bones  has  become  adapted 
to  the  weight  of  the  bodv  in  the  new  position.  Pain  is  apt 


FIG.  132.  Great  irregularity  of  the 
spinal  column,  in  a  case  of  te- 
dious convalescence,  after  typiioid 
fever.  Shows  the  effect  of  re- 
maining almost  constantly  on 
the  right  side. 


FIG.  133.  Corrective  effect  of  ex- 
tension of  ieft  arm  so  as  to  in- 
fluence the  irregularity  of  the 
spinal  column  due  to  weakness. 


to  be  associated  with  a  functional  curve,  because  such  a 
curve  puts  muscles  and  ligaments  on  a  stretch.  As  the  bones 
and  intervertebral  discs  gradually  yield  to  the  unequal  pres- 
sure of  a  functional  curve,  rotation  takes  place,  according  to 


PRINCIPLES  OF  OSTEOPATHY 


319 


the  laws  which  govern  rotation  in  the  dorsal  and  lumbar 
regions,  and  a  compensatory  condition  results,  which  we  rec- 
ognize as  a  right  dorsal  left  lumbar  scoliosis,  or  the  reverse. 

Caries. — 2.     Actual   disease   of  vertebrae   may  be   the 
cause  of  backache.     Such  a  condition  is  usually  a  localized 


FIG.  134.  Structural  lateral  curva- 
ture and  kyphosis,  great  rigidity, 
no  pain  or  discomfort. 


caries  due  to  tuberculosis.  Caries  is  characterized  by  angu- 
lar deformity,  great  sensitiveness  to  digital  pressure  and 
especially  to  vertical  pressure;  i.  e.,  any  addition  to  the 
weight  of  the  body  above  the  involved  vertebrae.  Localized 
backache  associated  with  a  prominent  spinous  process  and 


320  PRINCIPLES  OF  OSTEOPATHY 

sensitiveness   to   vertical    pressure   should   be    sufficient   to 
cause  any  physician  to  suspicion  the  existence  of  caries. 

Rigidity. — Kven  these  conditions  without  apparent  de- 
formity should  make  one  hesitate  before  using  any  leverage 
through  that  area.  One  of  the  characteristics  of  localized 
backache  in  disease  of  the  structure  of  the  spinal  column 
is  rigidity,  i.  e.,  the  body  protects  itself  by  muscular  ten- 
sion sufficient  to  limit  or  prevent  movement  in  the  in- 
flamed area.  Whenever  this  protective  phenomenon  is 
observed  it  should  be  a  warning  against  interference,  until 
one  is  convinced  that  more  is  to  be  gained  than  lost  by 
interfering  with  nature's  protective  mechanism. 

Arthropathies. — Cases  of  paresis  and  tabes  dorsalis  are 
subject  to  arthropathies  and  hence  heavy  manipulation,  of  a 
leverage  or  thrusting  type,  should  be  avoided.  There  is  dan- 
ger that  an  arthropathy  may  exist,  and  as  such  conditions 
are  not  characterized  by  pain,  the  normal  protective  mechan- 
ism does  not  assert  itself.  Fig.  135  shows  an  angular  de- 
formity in  a  case  of  paresis.  The  deformity  was  caused  by 
severe  manipulation  by  one  who  had  no  knowledge  of  path- 
ology or,  in  fact,  any  of  the  basic  medical  sciences.  This 
woman  had  a  comparatively  straight  spinal  column  which 
exhibited  some  stiffness  and  sensitiveness,  eighth  to  twelfth 
dorsal.  The  woman  was  placed  on  her  back,  knees  doubled 
under  her  chin,  then  rolled  on  to  her  shoulders  and  a  heavy 
downward  thrust  given  so  as  to  strongly  flex  the  lower  dor- 
sal. The  sharp  kyphosis  was  instantly  produced,  with  re- 
sulting pressure  on  the  spinal  cord. 

Spondylitis  Deformans. — A  general  posterior  curve  with 
ankylosis,  or  diminished  flexibility,  thickened  spinous  pro- 
cesses, tenderness  to  digital  pressure,  localized  pains,  not 
markedly  sensitive  to  vertical  pressure,  is  recognized  as 
spondylitis  deformans.  Other  joints  of  the  body  are  usually 
similarly  affected. 

Rachitis. — The  changes  due  to  malnutrition,  rachitis, 
are  frequently  recognized.  The  fact  that  changes  elsewhere 


PRINCIPLES  OF  OSTEOPATHY 


321 


FIG.  135.  An  angular  kyphosis  produced  in  a 
case  of  paresis  by  severe  flexion  and  com- 
pression, by  an  ignorant  pretender. 


322  PRINCIPLES  OF  OSTEOPATHY 

are  apt  to  more  positively  indicate  the  previous  existence  of 
rachitis  makes  diagnosis  comparatively  easy. 

Malignant  Growths. — When  localized  backache  is  com- 
plained of  and  no  deformity  is  evident,  thorough  tests  should 
be  made  to  determine  the  effects  of  positions  and  move- 
ments. The  protective  contraction  of  the  muscles  should 
be  carefully  analyzed,  so  as  to  judge  whether  the  pain  is  due 
to  any  inflammatory  process  involving  the  vertebrae,  or  any 
of  their  joints.  Nearly  all  pains  in  the  lumbar  region  are 
called  "lumbago,"  but  one  must  always  be  on  guard  lest  a 
persistent  lumbago-like  pain  be  not  given  its  true  value. 
Pains  of  a  sharp,  lancinating  character  which  persistently 
appear  in  a  definite  spinal  area  or  along  nerve  trunks  orig- 
inating from  that  area,  usually  have  a  sinister  significance. 
A  definite  diagnosis  is  practically  impossible,  but  the  per- 
sistence of  the  pains,  in  spite  of  all  efforts  to  relieve  with 
heat,  positions  of  rest,  or  manipulations,  is  pretty  good  evi- 
dence that  some  malignant  process  is  at  work  which  involves 
these  spinal  tissues.  If  no  fever  exists,  or  other  constitu- 
tional sign,  it  may  be  that  the  pain  is  due  to  involvement  of 
the  spinal  column  by  a  growth  within  the  body.  As  exam- 
ple, a  man.  44  years  old.  complained  bitterly  of  sharp  lan- 
cinating pains  in  the  lumbar  region  and  extending  down 
branches  of  the  lumbar  and  sacral  plexuses.  All  efforts  at 
relief  were  unavailing.  There  was  no  deformity  of  the 
spinal  column,  but  the  patient  held  himself  rigid.  Many 
attempts  were  made  by  many  physicians  to  make  a  diag- 
nosis. One  of  them  used  heavy  manipulation  of  a  leverage 
character.  In  order  to  test  the  effect  of  vertical  pressure  he 
used  a  concussing  blow  on  the  top  of  the  head  and  then  on 
the  heels.  This  latter  produced  agonizing  pain  which  was 
followed  rapidly  by  paraplegia.  The  case  ran  a  tedious 
course  of  many  months.  Autopsy  showed  cancer  involving 
left  kidney  and  the  spinal  area  under  it.  The  progress  of 
the  disease  was  exceedingly  slow  and  hence  his  body  was 
able  to  bring  many  compensatory  mechanisms  into  action, 


PRINCIPLES  OF  OSTEOPATHY  323 

which  made  it  difficult  for  even  the  most  skillful  to  recog- 
nize the  true  condition. 

Typhoid  Spine. — The  so-called  "typhoid  spine"  is  an- 
other form  of  spinal  trouble,  without  deformity,  which  may 
be  a  spondylitis  but  probably  is  a  pure  neurosis. 

Lumbago.  3.  Under  this  head  we  may  collect  a  va- 
riety of  conditions  which  are  characterized  by  pain  which 
is  particularly  aggravated  by  voluntary  movement.  It  is 
ofttimes  difficult  to  determine  what  the  structural  change 
is  which  gives  rise  to  this  pain.  Each  case  will  show  peculi- 
arities as  to  the  exact  location  of  the  pain  and  the  amount 
of  possible  voluntary  movement.  There  may  be  involv- 
ment  of  muscle,  ligament,  fascia,  or  periosteum.  The  cause 
of  the  trouble  may  be  fatigue  as  result  of  posture,  strain 
from  lifting,  or  may  be  due  to  a  toxemia. 

Posture. — Backache,  due  to  posture,  is  commonly  pro- 
duced in  any  one  who  attempts  to  do  work  which  com- 
pels bending  of  the  back  forward.  Until  such  time  as 
the  individual  develops  adaptation  to  this  position  there 
will  be  sensitiveness  at  those  points  in  the  spinal  column 
which  endure  the  greatest  strain.  The  strain  thus  pro- 
duced may  affect  the  extensor  muscles  of  the  back,  or  in 
case  the  posture  is  such  as  puts  strain  on  ligaments,  there 
will  be  hyperesthetic  points  directly  on  the  vertebral  spinous 
processes  where  the  supraspinous  ligaments  attach.  Back- 
ache due  to  strain  is  not  characterized  by  fever.  The  re- 
cumbent position  gives  relief. 

Toxemia. — Backache  due  to  toxemia  is  nearly  always 
of  sudden  appearance.  The  fact  that  the  patient  first  be- 
comes conscious  of  its  existence  when  some  movement  is 
made  such  as  quickly  sitting  up  in  bed,  or  bending  for- 
ward to  pick  up  something,  or  putting  on  clothing,  always 
leads  to  the  belief  that  the  pain  is  due  to  strain.  Nearly 
all  such  cases  show  a  coated  tongue,  bad  breath,  constipa- 
tion, headache,  and  general  physical  depression.  The  pain 


324 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  136.  A  swelling  under  the  sheath  of  the 
left  erector  spinae  muscle,  which  was  coin- 
cident with  an  attack  of  "lumbago,"  follow- 
ing a  heavy  strain. 


PRINCIPLES  OF  OSTEOPATHY  325 

is  not  necessarily  located  in  the  erector  spinae  muscles.  It 
is  frequently  localized  around  the  fifth  lumbar  spinous 
process,  which  is  exceedingly  sensitive  to  digital  pressure. 
There  may  be  some  fever  in  the  cases  for  twenty-four  hours. 
Thorough  catharsis  is  indicated  and  usually  is  followed 
by  rapid  decrease  in  pain.  The  pain  in  most  of  these  cases 
is  only  present  during  voluntary  movement.  The  physician 
can  usually  give  quite  extensive  passive  movement  with- 
out causing  severe  pain. 

Trauma. — A  genuine  trauma  of  the  extensor  muscles 
or  ligaments  of  the  back  usually  has  enough  of  positive 
history  to  classify  it  with  sprains  of  other  joints.  Rest, 
heat  and  gentle  manipulation  are  indicated.  In  these  cases 
the  protective  mechanism  heretofore  mentioned,  that  is, 
muscular  tension  to  prevent  movement,  is  very  apparent. 
Relief  from  pain  is  usually  quickly  attained  by  a  position 
of  rest  which  makes  no  demand  on  the  strained  tissues. 
There  may  be  localized  swelling  under  the  aponeurosis  cov- 
ering the  erector  spinae.  Fig.  136  shows  such  a  swelling 
caused  by  a  severe  lift.  The  patient  was  a  lumber  shover. 
He  was  assisting  in  handling  a  heavy  timber  when  the 
greater  portion  of  the  weight  came  suddenly  upon  him. 
Another  case,  whose  back  had  a  swelling  of  similar  char- 
acter and  history  of  repeated  attacks  of  "lumbago,"  but  no 
history  of  trauma,  proved  to  be  sarcoma  involving  both 
muscle  and  bone  in  this  area. 

"Crick  in  the  Back."— The  so-called  "crick  in  the  back" 
is  characterized  by  a  sudden  onset  and  excruciating  pain. 
It  appears  to  be  due  to  some  sudden  movement  which  or- 
dinarily puts  no  strain  upon  any  tissue.  They  are  not  lim- 
ited to  any  particular  area  of  the  back,  but  are  as  apt  to 
appear  in  the  neck  or  interscapular  area  as  in  the  lumbar 
area.  All  such  attacks  are  rather  severe  during  the  first 
day  but  usually  subside  under  heat  and  manipulation. 
These  attacks  seem  to  be  associated  with  a  constitutional 
state  and  hence  tend  to  recur  at  certain  seasons  or  under 


326  PRINCIPLES  OF  OSTEOPATHY 

certain  conditions  of  the  atmosphere,  especially  cold,  dry, 
electrical  winds.  Although  these  cases  show  some  signs 
of  indigestion  they  do  not  seem  to  be  of  the  same  char- 
acter as  those  we  have  previously  mentioned. 

Involvement  of  the  Spinal  Cord.  4.  Pain  in  the  back 
may  be  due  to  some  involvement  of  the  spinal  cord  or  its 
membranes.  As  a  general  rule  there  are  enough  other 
symptoms  such  as  motor  or  sensory  phenomena  to  direct 
one's  attention  to  the  real  seat  of  disease.  The  pain  in 
these  cases  is  likely  to  be  symmetrical  or  at  least  definitely 
located  with  respect  to  certain  spinal  nerve  trunks.  Fur- 
thermore, pain  due  to  involvement  of  the  cord,  or  its  men- 
inges,  does  not  call  forth  the  protective  reflexes  which  are 
so  evident  when  any  structural  tissue  of  the  spinal  column 
is  involved.  There  is  no  necessity  for  rigidity  to  protect 
supporting  tissues.  (We  are  not  including  spinal  menin- 
gitis in  this  group.)  When  the  nerve  roots  are  involved 
the  pain  is  intense  and  definitely  located.  When  the  root 
ganglia  are  involved  we  have  the  well  known  condition 
called  herpes  zoster. 

Infectious  Fevers.  5.  Many  of  the  acute  infectious 
fevers  are  characterized,  in  part,  by  severe  backache.  In- 
fluenza, tonsilitis,  smallpox,  typhoid,  diphtheria  and  dengue 
all  have  severe  backaches  as  an  incident  in  their  course.  It 
is  not  kijown  what  produces  the  pain  in  these  fevers. 

Referred  Visceral  Pains.  6.  Probably  the  great  pro- 
portion of  backaches  are  referred  pains  due  to  involvement 
of  thoracic,  abdominal  or  pelvic  viscera.  Attention  has 
already  been  called  to  Head's  law  of  referred  pain, 
and  to  the  existence  of  the  receptor  fields  for  sensory 
impressions  for  certain  segments  of  the  spinal  cord.  The 
intero-ceptive  field  is  an  area  of  low  sensibility,  so  far  as 
our  conscious  recognition  of  this  field  is  concerned.  Not 
all  segments  of  the  spinal  cord  receive  sensory  fibers  from 
this  field,  hence  visceral  reflexes  are  found  only  in  those 
portions  of  the  back  associated  with  those  segments  having 


PRINCIPLES  OF  OSTEOPATHY 


327 


FIG.  137.  An  occupation  curve  with  flattening  in 
the  upper  dorsal.  Telegrapher.  Patient  com- 
plained of  pain  and  tenderness,  second  to 
fourth  dorsal  on  the  left  side.  Died  sixty  days 
after  the  photo  was  made,  angina  pectoris. 


328  PRINCIPLES  OF  OSTEOPATHY 

intero-ceptive  sensory  communication.  Disturbances  in 
hollow  viscera  such  as  the  stomach  and  intestines  are  due 
to  overloading  the  digestive  apparatus.  Fatigue  and  con- 
sequent failure  of  digestion  leads  to  distention  with  gas, 
absorption  of  toxins,  faulty  elimination.  Distention  causes 
pressure  on  nerve  endings  in  the  walls  of  the  viscera  and 
thus  initiates  reflex  backache.  Exaggeration  of  physio- 
logical activitv  of  the  liver,  or  spleen,  causes  tension  on  the 

o  «* 

capsules  of  those  organs  and  hence  irritation  of  their  sensory 
nerves  with  reflex  back  pains.  The  same  is  true  of  the  kid- 
ney. Disturbances  in  the  blood  supply  to  any  organ,  such 
as  occurs  in  arterio-sclerosis,  or  as  result  of  aneurism,  usu- 
ally cause  referred  pains.  The  referred  pains  that  are  due 
to  functional  fatigue  are  usually  of  a  somewhat  different 
character  from  those  due  to  inflammation  in  visceral  or- 
gans. Acute  inflammatory  states  in  the  viscera  give  rise 
in  many  instances,  to  cutaneous  hypersensitiveness  in  their 
segmentally  associated  areas.  These  cutaneous  areas  are 
hypersensitive  to  a  slight  touch  but  not  especially  so  to 
pressure.  States  of  functional  strain  and  fatigue,  whether 
acute  or  chronic,  are  more  apt  to  produce  a  reflex,  in  the 
spinal  area,  which  is  characterized  by  tenderness  to  pres- 
sure over  the  extensor  muscles  at^some  point  between  the 
spinous  processes  of  the  vertebrae  and  the  angles  of  the 
ribs.  Cutaneous  and  deep  tissue  hypersensibility  may  be 
associated  in  the  same  case.  The  deep  hypersensibility 
is  the  more  constant  form  discovered  by  palpation. 

Inflammation  of  Serous  Membranes. — Wherever  the 
necessity  for  friction  of  one  organ,  or  structure,  on  another 
is  necessary,  we  find  serous  tissue  in  the  form  of  a  bursa, 
tendon,  sheath,  synovial  membrane,  tunica  vaginalis  testis, 
pleura,  pericardium  or  peritoneum.  Inflammation  of  a 
serous  membrane  is  accompanied  by  muscular  fixation  of 
the  structures  which  depend  on  that  membrane  for  free 
movement.  This  is  a  protective  action  required  to  prevent 
friction  of  the  inflamed  surfaces.  Inflammation  of  a  pleural 
surface  calls  forth  a  protective  contraction  of  all  the  muscles 


PRINCIPLES  OF  OSTEOPATHY  329 

which  are  concerned  in  producing  movements  which  re- 
quire the  co-operation  of  that  pleural  surface.  If  pleural 
effusion  occurs  there  is  still  an  increased  muscular  tension, 
although  not  so  spasmodic  as  when  no  effusion  exists. 

Colicy  Pain. — Gall  stone  colic,  intestinal  colic,  renal 
colic  and  appendicitis  all  cause  severe  reflexes,  deep  mus- 
cular as  well  as  cutaneous,  in  the  areas  innervated  from 
the  same  segments  of  the  cord.  These  reflexes  are  found 
in  areas  of  greater  extent  than  those  properly  associated 
with  these  visceral  structures.  The  severity  of  these  colicy 
pains  undoubtedly  excites  an  overflow  of  stimuli  into  seg- 
ments above  and  below  those  which  directly  innervate  these 
structures.  • 

Summary. — For  the  purpose  of  bringing  some  of  the 
various  causes  of  reflex  pain  into  orderly  arrangement  we 
may  classify  them  as  follows : 

1.  Due   to   functional   strain   of  viscera,   e.   g.,   diges- 
tion of  a  very  rich  meal. 

2.  Due  to  distension  of  a  hollow  viscus,  or  stretch- 
ing of  the  fibrous  capsule  of  an  organ. 

3.  Due  to  inflammation  of  the  serous  investment  of  a 
viscus. 

4.  Due  to  disturbance  of  circulation  in  visceral  blood 
vessels  caused  by  disturbed  mental  condition,  or  on  account 
of  a  pathological  change  in  the  walls  of  the  arteries,  arterio- 
sclerosis. 

5.  Due  to  excessive  effort  to  overcome  obstruction  of 
the  lumen  of  hollow  organs  as  in  spasms  of  the  muscular 
coats  of  the  intestines,  common  bile  duct,  ureter  or  fallopian 
tube. 

Pluri-Segmental  Control  of  Viscera. — It  should  be  re- 
membered that,  as  a  general  rule,  the  reflexes  due  to  these 
causes  are  not  definitely  limited  in  extent,  either  as  to  skin 
areas,  or  groups  of  extensor  spinal  muscles.  Just  as  no 
skin  area,  or  single  muscle,  other  than  a  rudimentary  one 


330  PRINCIPLES  OF  OSTEOPATHY 

of  the  fifth  layer  of  the  hack,  is  completely  innervated  from 
a  single  segment  of  the  cord,  we  find  also  that  no  viscus 
is  wholly  controlled  by  fibers  from  one  segment. 

Reflex  Subluxations. — The  continuous  action  of  a  re- 
flex, such  as  that  due  to  inflammation  of  a  serous  surface, 
or  to  long  continued  functional  strain,  or  to  continued  cir- 
culatory disturbance,  usually  results  in  a  change  in  the 
character  of  the  back,  i.  e.,  a  certain  degree  of  static  altera- 
tion takes  place  as  a  compensatory  adaptation  to  varying 
degrees  of  muscular  ankylosis.  This  muscular  ankylosis 
is  the  expression  of  the  visceral  reflex.  It  produces  changes 
in  bony  alignment  which  we  recognize  as  subluxations 
when  only  three  or  four  vertebrae  are  affected;  or  as  curva- 
tures, when  greater  numbers  are  involved. 

Intensity  of  Reaction. — The  extent  and  complexity,  or 
intensity,  of  a  reflex,  or  co-ordinated  series  of  reflexes,  is 
not  a  criterion  by  which  to  estimate  the  extent  of  patho- 
logical change  in  a  viscus  or  viscera.  Very  serious  patho- 
logical changes  may  be  present  in  a  viscus  without  pro- 
ducing intense  or  even  determinable  spinal  reflexes.  These 
changes  may  have  progressed  so  slowly  and  involved  such 
small  areas  that  no  intense  protective  reaction  was  called 
forth. 

Location  of  Reflexes. — Based  upon  clinical  and  experi- 
mental observations,  a  considerable  amount  of  data  has  been 
secured  bearing  upon  the  location  of  reflexes  in  connection 
with  various  visceral  diseases.  The  data  with  respect  to 
the  location  of  cutaneous  hyperaesthesia  has  been  well 
mapped  out,  but  until  osteopaths  began  to  plan  their  manip- 
ulative treatment  according  to  the  structural  changes  in 
spinal  alignment,  due  to  muscular  hypertension,  there  was 
practically  no  attention  paid  to  the  phenomenon  of  reflex 
hypertension.  The  referred  visceral  pains  and  the  hyper- 
tension of  the  spinal  muscles  are  expressions  of  a  disturbed 
segment  or  segments  of  the  spinal  cord. 


PRINCIPLES  OF  OSTEOPATHY  331 

Reflex  Patterns. — Based  on  clinical  and  experimental 
data,  it  is  possible  to  outline  a  series  of  reflex  patterns  which 
are  characteristic  of  certain  visceral  involvments.  The 
complexity  of  the  patterns  depends  largely  on  how  great 
an  effort  is  required  by  the  body  to  overcome  the  disease. 
Some  diseases  have  a  spinal  reflex  pattern  apparently  out 
of  all  proportion  to  the  gravity  of  the  illness.  This  is  espe- 
cially marked  when  autotoxemia  is  a  characteristic  of  the 
illness.  Under  such  circumstances  muscular  tension  and 
tenderness  extend  far  outside  the  limits  of  the  normal  seg- 
mental  innervation. 


332  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  XVI. 

ADAPTATION    AND    COMPENSATION. 

Examination  of  patients  frequently  reveals  the  results 
of  accidents  or  disease  which  do  not  appear  to  have  any 
present  deleterious  influence  on  their  health.  It  is  always 
necessary  for  the  physician  to  estimate  the  relations  which 
these  changes  have,  in  the  past,  borne  to  the  general 
health,  or  may,  at  present,  be  liable  to  exert  under  known 
conditions  of  climate,  diet  and  environment. 

Definition. — In  speaking  of  structural  and  functional 
changes,  we  use  the  words  adaptation  or  compensation. 
Adaptation  means,  in  biology,  favorable  organic  modifica- 
tions suiting  a  plant  or  animal  to  its  environment.  Com- 
pensation means,  "to  make  up  for,"  "to  counterbalance," 
"that  which  makes  good  the  lack  or  variation  of  some- 
thing else."  The  examples  of  adaptation  and  compensa- 
tion are  very  numerous  and  it  is  necessary  for  the  physi- 
cian to  be  able  to  recognize  the  cases  in  which  the  body 
has  exercised,  or  may,  with  proper  assistance,  exercise 
this  power  to  a  great  degree.  It  is  sometimes  said  that 
disease  is  an  effort  of  the  body  to  accommodate  itself  to 
new  conditions,  that  is,  changes  in  the  quantity  and 
quality  of  stimuli  occasioned  by  variations  in  climate,  diet, 
environment  or  accident. 

Osteopathy  apparently  originated  from  the  fact  that 
structure  affects  function.  With  this  as  a  basis,  all  exam- 
inations are  made  from  the  structural  standpoint  and 
therefore,  if  we  follow  this  method  too  literally,  we  are 
apt  to  overlook  the  fact  that  the  cells  of  our  bodies  have 
the  power  of  adapting  themselves  to  very  pronounced 


PRINCIPLES  OF  OSTEOPATHY  333 

changes  in  all  those  things  which  are  considered  essen- 
tial to  perfect  functioning.  Function  in  these  affected 
cells  may  not  be  perfect,  measured  by  their  former  ac- 
tivity, and  yet  apparently  answer  all  the  demands  made 
upon  them  by  the  conscious  or  sympathetic  life  of  the 
individual.  There  may  be  other  cells,  somewhat  similar  in 
character,  whose  increased  activity  can  compensate,  that 
is,  "make  good  the  lack  of"  activity  in  the  affected  cells. 

The  Spinal  Column. — The  examination  of  the  spine 
frequently  reveals  the  irregularities  in  its  structure.  Dis- 
turbed function  in  some  viscus  or  other  group  of  tissues 
is  sometimes  attributed  to  this  structural  variation,  even 
when  no  direct  nerve  influence  over  the  affected  tissues 
can  be  directly  traced  to  the  spinal  area.  Mere  change 
in  structure,  cannot  warrant  us  in  considering  it  primary 
to  a  functional  disturbance,  which  does  not  exist  in  a  lo- 
cation whose  control  can  be  traced  to  it.  The  effort  on 
our  part  to  always  connect  structure  with  function,  hav- 
ing the  relations  of  cause  and  effect,  sometimes  leads  to 
very  far-fetched  reasoning.  It  is  necessary  for  us  to  de- 
cide, in  a  given  case,  whether  or  not  the  present  condi- 
tion of  the  individual  is  as  good  as  it  can  be  made.  Our 
decision  will  manifest  to  the  keen  observer  whether  we 
have  recognized  the  extent  of  possible  adaptation  and 
compensation. 

Curvatures  of  the  spine  present  many  phases  which 
must  be  considered  before  treatment  is  begun.  The  cur- 
vature of  an  old  case  of  Pott's  disease  seldom  affects  sym- 
pathetic life  to  the  extent  that  we  would  expect.  The 
very  gradual  progress  of  this  disease  seems  to  give  ample 
opportunity  for  the  structures,  in  close  relation  to  the 
diseased  area,  to  accommodate  themselves  to  the  changed 
conditions.  It  is  hardly  conceivable  that  anyone  would 
fail  to  recognize  the  accommodation  manifested  in  these 
cases,  and  yet  we  have  heard  of  those  who  advocated 
forcible  straightening  of  the  spine.  The  question  to  be 
decided  is  whether  it  is  better  to  risk  life  by  forcible 


334  PRINCIPLES  OF  OSTEOPATHY 


FIG.  138.  Adaptation  of  the  body  to  the  state  of  its 
contents.  Enlargement  of  the  spleen  which  causes 
a  bulging  of  the  ribs  and  a  coincident  spinal  lesion. 


PRINCIPLES  OF  OSTEOPATHY  335 

straightening  of  the  spine  or  endure  deformity  with  fair 
health.  Deformity  is  always  a  wound  in  the  self-esteem 
of  the  individual.  Many  would  risk  life  time  and  again 
to  be  rid  of  it.  It  is  this  which  gives  the  experimenting 
physician  or  surgeon  ample  opportunity  to  try  his  skill 
or  his  ignorance.  It  is  all  one  to  the  patient,  a  chance 
to  be  rid  of  deformity. 

Compensatory  Curvature. — A  lateral  curvature  of  the 
spine  usually  has  two  parts,  the  primary  and  the  compen- 
satory curve.  The  compensatory  curve  is  the  effort  to 
maintain  the  erect  position,  that  is,  keep  the  weight  of 
the  body  properly  balanced.  The  physician  must  determine 
which  curve  is  primary  and  which  is  compensatory. 

When  the  hip  is  dislocated,  or  any  condition  exists 
which  shortens  one  leg,  the  spinal  column  is  curved  to 
compensate  for  this  reduced  length.  It  would  be  useless 
to  treat  a  compensatory  spinal  curvature,  without  length- 
ening the  leg  by  reducing  a  hip  dislocation  or  putting 
an  extension  on  the  shoe.  When  the  femur  is  dislocated, 
all  the  thigh  and  hip  muscles  accommodate  themselves 
to  a  new  position,  then  the  spinal  column  curves  because 
the  pelvis  tilts  enough  to  compensate  for  the  lack  of 
length  in  the  extremity.  The  longer  the  dislocation  has 
existed  the  more  perfect  is  the  adaptation  and  compensa- 
tion. To  reduce  the  dislocation  we  must  undo  the  work 
of  adaptation,  that  is,  lengthen  the  muscles  and  force  the 
head  of  the  femur  into  the  acetabulum. 

All  individual  spinal  lesions  must  be  judged  careful- 
ly as  to  their  relations  to  functional  disturbance.  The 
fact  that  spines  develop  unevenly,  in  many  cases,  makes  it 
hard  to  define  their  exact  condition.  A  lateral  subluxa- 
tion  may  exist  to  which  the  body  has  become  accommo- 
dated. To  reduce  this  subluxation  might  again  subject 
the  individual  to  disturbed  function. 

The  Thorax. — Drooping  of  the  ribs  lessens  the  an- 
tero-posterior  diameter,  but  increases  the  vertical  diam- 
eter. The  full  round  chest  of  large  capacity  is  usually 


336  PRINCIPLES  OF  OSTEOPATHY 

less  flexible  and  active  than  the  small  chest.  The  ques- 
tion in  each  case  is  whether  the  thorax  is  doing  the 
amount  of  work  necessary  for  the  body.  The  chest  may 
show  evidence  of  a  period  of  malnutrition,  during  child- 
hood, that  is,  "rickets."  There  may  be  evidences  of  the 
effects  of  occupation.  In  any  case  of  deformed  thorax 


FIG.  139.  Posterior  view  of  a  case  of  leukemia,  showing 
spinal  area  involved  in  adaptation  of  the  body  wall  to 
its  contents. 


PRINCIPLES  OF  OSTEOPATHY  337 

the  question  uppermost  in  our  minds  should  be :  "What  is 
its  functional  capacity?" 

The  Heart.  —  Compensation  by  the  heart,  for  some 
mechanical  defect  in  it,  is  the  most  interesting  subject 
studied  by  the  physician.  As  a  result  of  contraction  of 
the  orifices  of  the  heart,  or  faulty  action  of  its  valves,  there 


FIG.    140.     Anterior  view  of   case   of   leukemia,    showing   outline   of 
the  enlarged  spleen. 


338  PRINCIPLES  OF  OSTEOPATHY 

is  an  increase  in  the  size  of  one  or  more  of  its  chambers. 
This  increase  is  at  the  expense  of  the  thickness  of  its 
walls,  thus  resulting1  in  disproportion  between  the  size  of 
the  cavity  of  the  ventricle  or  auricle,  and  the  amount  of 
muscular  tissue  required  to  empty  them  of  their  contents. 
When  the  proportion  between  the  cavity  and  its  walls 
is  so  far  restored  that  the  heart  is  able  to  overcome  the 
stasis  of  the  blood  in  that  portion  of  the  circulatory  ap- 
paratus behind  the  lesion,  we  say  that  compensation  ex- 
ists. The  ability  to  recognize  the  status  of  a  heart  lesion 
is  of  great  value  to  a  physician. 

Skin  and  Kidneys. — A  spinal  lesion  might  cause  a  dis- 
turbance in  the  functioning  of  the  kidneys,  decrease  of 
activity,  which  in  turn  is  compensated  for  by  increased 
activity  of  the  skin,  which  in  time  is  compensated  for  by 
increased  activity  of  the  bowels.  The  diarrhoea  in  this 
case  would  be  compensatory,  and  yet  it  is  very  difficult 
for  the  physician  to  note  this  fact.  If  therapeutic  means 
were  used  to  stop  the  diarrhoea,  and  the  kidneys  or  skin 
did  not  immediately  take  up  the  work  of  elimination,  the 
body  would  call  upon  the  serous  membranes  and  areolar 
tissue,  to  take  care  of  the  surplus  liquid  in  the  circulation. 
As  a  result  there  would  be  edema  of  the  extremities,  as- 
cites,  pleuritic  effusion. 

The  compensating  action  which  may  take  place  be- 
tween the  kidneys,  skin,  mucous  and  serous  membranes,  is 
one  which  is  more  frequently  recognized  and  made  use 
of  by  physicians  than  any  other  example  of  the  same  pow- 
er manifested  in  the  body.  The  fact  that  the  skin  and  kid- 
neys respond  to  each  other's  needs,  forms  the  basis  for 
many  therapeutic  procedures.  Mucous  membranes  be- 
come active  when  the  skin  fails.  Perspiration  reduces 
activity  of  the  mucous  membranes.  Serous  membranes 
cease  their  excessive  activity  when  mucous  membranes 
eliminate  freely.  The  oedema  of  areolar  tissue  gives  way 
to  activity  of  mucous  membranes.  The  physician  must 


PRINCIPLES  OF  OSTEOPATHY 


339 


recognize  which  is  the  diseased  tissue,  and  which  is  the 
compensating  one.  The  failure  of  the  kidney  to  excrete 
might  not  be  the  fault  of  its  own  structure,  but  result 
from  the  vis  a  tergo  given  the  circulation  by  a  diseased 
heart. 

Power  of   Encysting. — In   this   western   country,   Cali- 
fornia, we  have  ample  opportunity  to  witness  the  ability 


FIG.  141.  Side  view  of  case  of  leukemia,  showing  re- 
sult of  adaptation  of  the  spinal  column  and  ribs 
to  the  contents  of  the  body. 


340 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    112.     Plantar    impression    of    almost    com- 
plete letting  down   of  the  longitudinal  arch. 


PRINCIPLES  OF  OSTEOPATHY  341 

of  individuals  to  do  hard,  tedious  work,  after  a  considera- 
ble portion  of  the  lung  has  been  destroyed  by  disease. 
The  healing-  which  takes  place  under  favorable  climatic 
conditions,  seems  to  leave  the  remainder  of  the  lung  in 
perfect  functional  condition.  We  have  examined  two 
cases,  in  which  the  whole  right  lung  was  destroyed,  and 
the  heart  had  been  drawn  into  the  right  half  of  the  thorax. 
Both  of  these  individuals  were  able  to  compete  with  their 
more  perfect  fellows  for  a  living,  by  doing  hard  manual 
labor.  One  of  these  patients  had  a  discharging  abscess 
in  the  axillary  line,  between  the  ninth  and  tenth  ribs.  This 
abscess  had  discharged  continuously  for  four  years.  The 
patient  did  not  complain  of  a  single  symptom  of  ill  health. 
He  earned  his  living  as  a  miner.  This  shows  how  thor- 
oughly the  system  may  become  accommodated  to  very 
marked  changes  in  the  condition  of  its  tissues.  This  ab- 
scess was  in  the  man,  but  apparently  not  affecting  his 
functions.  Probably  the  abscess  was  walled  off  from  the 
active  body  tissues  by  a  protective  membrane. 

The  history  of  the  lodgment  of  bullets  in  various  por- 
tions of  the  body,  demonstrates  that  what  cannot  be  thrown 
off  by  ordinary  means,  may  become  encysted,  and  thus 
not  interfere  with  the  activity  of  the  tissues. 

The  Extremities. — Adaptation  and  compensation  can 
be  noted  very  quickly  in  many  cases  of  injury  of  the 
extremities.  A  fixed  scapulo-humeral  articulation  is  par- 
tially compensated  for  by  increased  mobility  of  the  scapula 
on  the  thorax.  When  the  anterior  tibal  group  of  muscles 
is  paralyzed,  the  patient  compensates  for  inability  to  raise 
the  toe,  by  flexing  the  thigh.  When  the  hip  joint  is  fixed 
in  the  extended  position,  the  lumbar  portion  of  the  spinal 
column  becomes  very  flexible. 

Law. — All  living  things  strive  to  preserve  themselves. 
This  means  they  do  the  best  they  can  under  all  conditions. 
In  order  to  do  this  they  must  adapt  themselves  to  changes 
in  the  character  of  their  environment  and  compensate  for 


342  PRINCIPLES  OF  OSTEOPATHY 


FIG.  143.  Plantar  impression  of  case  of  absolute  flat 
foot.  The  longitudinal  arch  is  completely  broken 
down. 


PRINCIPLES  OF  OSTEOPATHY 


343 


FIG.  144.  Plantar  impression  of  loss  of  trans- 
verse arch,  and  consequent  increase  of  pres- 
sure on  the  head  of  the  second,  third  and 
fourth  metatarsal  bones,  as  evidenced  by 
the  callous. 


344  PRINCIPLES  OF  OSTEOPATHY 

injuries  to,  or  losses  of  their  own  structure.  Adaptation 
to  external  conditions  calls  for  the  operation  of  compen- 
sating or  balancing  devices  within  the  organism,  there- 
fore the  logical  study  of  this  subject  would  naturally  group 
the  phenomena  under  three  heads.  First,  the  study  of 
structure,  with  a  view  to  determining  the  existence  of 
balancing  devices  in  the  arrangement  of  bones,  ligaments, 
muscles,  blood  vessels,  viscera  and  nerves.  These  com- 
pensatory mechanisms  must  be  considered  in  every  effort 
at  adaptation.  This  first  division  deals  with  internal 
structural  conditions,  and  their  functions,  i.  e.,  anatomy 
and  physiology.  Second,  the  study  of  conditions  under 
which  living  structures  are  existing.  This  division  deals 
with  all  those  things  which  constitute  environment,  .such 
as  food,  temperature,  atmospheric  pressure;  relation  to 
other  living  things,  such  as  insects,  protozoa  and  bac- 
teria; animal  and  vegetable  poisons.  Third,  a  logical  out- 
growth of  the  first  and  second  divisions,  i.  e.,  a  study  of 
the  artificial  conditions  used  by  physicians  to  influence 
the  natural  conditions  of  the  first  and  second  divisions. 

Since  man's  position  is  upright,  it  appears  that  all 
parts  of  his  body  are  constructed  with  the  end  in  view 
of  making  that  position  easy  to  maintain.  A  bewilder- 
ing series  of  compensating  devices  serve  to  balance  the 
body  in  the  upright  position.  Any  deviation  of  any  part, 
as  the  result  of  accident  or  necessity,  is  immediately  me<" 
by  an  opposing  counterbalancing  effort  of  its  natural 
compensatory  opposing  structure.  If  this  compensatory 
effort  is  not  present,  there  is  loss  of  balance  between  re- 
ciprocating parts,  resulting  in  strain  and  discomfort.  As 
a  general  proposition  the  foregoing  is  recognized  by  all, 
but  to  actually  recognize  the  failure  of  compensation, 
the  presence  of  strain,  imbalance,  requires  knowledge  of 
the  structure  of  reciprocating  parts. 

The  feet  present  some  interesting  mechanisms  for 
responding  to  the  needs  of  the  body  in  balancing  in  the 
upright  position.  Every  change  in  shoe  last  calls  for  a 


PRINCIPLES  OF  OSTEOPATHY  345 

compensatory  change  in  the  relation  of  tarsal,  metatarsal 
and  phalangeal  joints,  with  the  consequent  changes  in 
muscular  tension,  to  meet  the  demands  of  maintaining  the 
equilibrium  of  the  body.  The  bursae  which  lie  under  the 
skin  areas,  which  are  subject  to  pressure,  vary  considera- 
bly. Their  compensatory  character  is  well  illustrated 
in  the  different  forms  of  club-foot.  A  bursa  is  usually 
located  in  such  deformities  wherever  needed  to  protect 
the  bony  points  from  friction.  Figs.  89,  142,  143  and  144 
show  plantar  impressions  of  feet  with  varying  degrees 
of  weakness  in  the  longitudinal  or  transverse  arches. 
Two  of  these  cases  had  been  treated  for  backache  and  in- 
nominate lesions,  without  success.  The  reason  for  the 
failure  is  well  illustrated  by  these  plantar  impressions. 

The  adaptive  and  compensative  changes,  which  are 
so  readily  observed  in  the  human  foot,  present  very  many 
phenomena  which  should  be  patent  to  all  students  of 
medicine.  The  fact  remains  that  physicians  fail  with  as- 
tonishing frequency  to  take  account  of  these  phenomena, 
therefore  we  feel  warranted  in  giving  attention  to  this 
subject. 

The  case  which  is  here  described  and  illustrated  was 
sent  to  me  by  Dr.  Geo.  F.  Martin,  of  Tucson,  Ariz.  Mr. 
C.,  age  about  28,  interested  in  mining  enterprises,  applied 
for  relief  from  pain  in  the  right  foot  and  leg.  Examina- 
tion revealed  a  high,  swollen  instep,  and  measurement  of 
the  length  of  the  foot  showed  it  to  be  one-half  inch 
shorter  than  the  left.  The  ankle  did  not  appear  to  be  in- 
volved. The  top  of  the  instep  felt  bony,  instead  of  pulpy, 
as  might  be  expected  from  the  appearance.  Palpation  of 
the  inner  side  of  the  longitudinal  arch  showed  that  some 
decided  change  had  taken  place  in  the  astragalo-scaphoid 
articulation.  Just  posterior  to  the  scaphoid  tubercle,  in- 
stead of  feeling  the  astragalus,  a  depression  was  noted  and 
this  depression  was  continuous  with  a  sort  of  groove 
which  passed  across  the  instep,  from  internal  to  external 
maleollus.  Fig.  145.  When  the  patient  stood  on  the  foot 


346 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    145.     Anterior    view   of   old    fracture 
of  the  scaphoid. 


PIG.    146.     Side    view    of    old    fracture    of 
the   scaphoid. 


this  groove  was  decidedly  apparent.  Fig.  146.  Palpation, 
while  the  weight  was  on  the  arch,  seemed  to  indicate  that 
the  tibia  and  fibula  held  a  relation  to  the  astragalas  sim- 
ilar to  that  which  is  normal  when  the  foot  is  extended 
on  the  leg,  i.  e.,  the  posterior  portion  of  the  superior  sur- 
face of  the  astragalus  was  bearing  the  weight.  The  short- 
ening of  the  foot,  height  of  the  instep,  inability  to  pal- 
pate perfect  continuity  of  the  internal  side  of  the  longi- 
tudinal arch  and  existence  of  groove  just  in  front  of  the 
ankle  joint,  together  with  slight  swelling  but  no  edema, 
dilated  veins  and  dull  pain  in  the  arch  and  leg,  but  no 
loss  of  function,  (i.  e.,  mobility  existed  in  all  tarsal  and 
metatarsal  articulations)  were  indicative  of  some  decided 
structural  changes.  The  principal  point  noted  about  the 


PRINCIPLES  OF  OSTEOPATHY 


347 


FIG.   147.     Radiograph  of  an  old  fracture  of  the  scaphoid  and  consequent 
displacement  of  the  astragalus. 


movements  was  that  inversion  and  eversion  of  the  foot 
took  place  with  the  foot  in  the  normal  relation  to  the  leg, 
as  though  it  was  extended,  thus  demonstrating  that  the 
astragalus  was  in  fact  in  a  position  of  extension,  even 
though  the  foot  appeared  not  to  be  so. 

The  condition  of  this  foot  is  exceedingly  interesting, 
when  the  history  is  considered.  Mr.  C.  says  his  foot  was 
injured  by  a  large  rock,  which  a  fellow  workman  acci- 
dentally dropped.  This  accident  took  place  four  years 
ago,  while  he  was  working  in  a  mine.  The  foot  swelled 
slightly,  i.  e.,  to  about  its  present  size  and  was  painful, 
but  did  not  incapacitate  him  for  work.  Claims  he  never 


348 


PRINCIPLES  OF  OSTEOPATHY 


lost  a  day  on  its  account,  and  it  was  not  examined  by  a 
physician.  The  swelling  gradually  subsided  and  the  foot 
gave  him  no  inconvenience  for  three  years,  except  in  the 
matter  of  fitting  a  shoe.  Recently  swelling  and  pain  have 
developed. 


FIG,  148.  Radiograph  of  an  old  fracture  of  the 
scaphoid,  showing  compensatory  rotation  of 
the  foot  on  to  its  outer  margin,  to  avoid  trans- 
mitting the  body  weight  through  the  longi- 
tudinal arch. 


PRINCIPLES  OF  OSTEOPATHY 


349 


My  first  suggestion,  based  on  the  insufficiency  of  the 
arch,  was  the  use  of  an  instep  supporter,  but  this  proved 
a  failure,  as  it  caused  his  foot  to  turn  on  the  outer  border. 
The  support  prevented  the  inner  side  of  the  arch  from 
lengthening  when  weight  was  put  on  it,  and  the  astraga- 
lus could  not  have  free  movement,  hence  the  foot  inclined 
toward  the  outer  side,  and  strained  the  ankle. 

Several  skiagraphs  were  made  which  were  very  sat- 
isfactory in  aiding  diagnosis.  The  first  one  was  made 
to  show  the  relation  of  the  tarsal  bones  on  their  superior- 
external  aspect.  Fig.  147.  This  shows  the  head  of  the 
astragalus  downward,  out  of  relation  to  the  scaphoid. 
Fig.  148  shows  a  view  directly  from  above  the  dorsum  of 
the  arch,  and  demonstrates  clearly  the  dislocation  of  the 
head  of  the  astragalus.  The  innei  side  of  the  longitu- 
dinal arch  is  not  complete,  and  what  there  is  of  it — sca- 


FIG.  149.     Radiograph  of  an  old  fracture   of   the    scaphoid,    showing   rela- 
tion of  the   head  of  the  astragalus  to   the  fractured   scaphoid. 


350 


PRINCIPLES  OF  OSTEOPATHY 


phoid,  internal  cuneiform  and  first  metatarsal — is  badly 
distorted.  The  relations  of  the  metatarsals,  as  shown  in 
this  illustration,  indicate  the  tendency  to  throw  the 
weight  on  the  outer  edge  of  the  foot.  The  side  view, 
shown  in  Kig.  \4()  demonstrates  again  the  dislocation  of 
the  head  of  the  astragalus  downward  to  a  position  under 
the  scaphoid.  The  scaphoid  shows  an  irregular  outline, 


FIG.  150.  Plantar  impression  show- 
ing effect  of  old  fracture  of 
scaphoid  and  consequent  downward 
movement  of  the  head  of  the  as- 
tragalus. 


PRINCIPLES  OF  OSTEOPATHY  351 

as  though  having  been  fractured  and  repaired,  leaving  ir- 
regular masses  of  callous. 

An  impression  of  the  plantar  surface  of  the  foot  was 
taken.  Fig.  150.  This  shows  the  great  increase  in  con- 
tact surface,  especially  under  the  head  of  the  astragalus. 
Another  interesting  thing  demonstrated  by  this  impres- 
sion is  the  change  that  has  taken  place  in  the  second  meta- 
tarsal,  and  second  toe.  Both  have  been  elevated  so  that 
they  no  longer  bear  much  direct  weight.  The  third  and 
fourth  metatarsals  are  bearing  the  direct  application  of 
the  weight  of  the  body. 

In  order  to  more  clearly  analyze  this  case,  we  will 
consider  some  general  fundamental  ideas  concerning  the 
structure  and  function  of  the  foot.  The  foot  acts,  pri- 
marily, as  a  passive  support  of  the  body  weight;  secon- 
darily, as  an  active  lever  to  move  this  weight,  as  in  run- 
ning. In  order  to  perform  these  functions,  it  must  have 
strength,  elasticity  and  adaptability,  thus  permitting  it 
to  assume  various  attitudes  necessary  to  protect  it  from 
injury.  Since  the  primary  function  of  the  foot  is  to  act 
as  a  support,  the  integrity  of  the  ligaments  is  essential. 
When  the  foot  is  passive  under  weight,  the  arches  settle 
slightly.  The  arch  as  a  whole  is  elastic,  but  the  ligaments 
are  not.  The  elasticity  of  the  arch  is  the  result  of  the 
movement  of  the  bones  into  a  position  where  the  liga- 
ments receive  the  weight.  Muscles,  ligaments  and  the 
plantar  fascia  all  serve  to  support  the  foot,  but  when 
passively  bearing  the  weight  of  the  body,  the  ligaments 
bear  the  strain.  Loss  of  elasticity  in  the  foot  causes  in- 
creased pressure  on  points  of  contact  on  the  sole  of  the 
foot,  also  on  the  toes.  The  skin  thickens  over  these  bony 
contact  points  in  an  effort  to  compensate  for  loss  of  elas- 
ticity, thus  corns  and  callouses  are  evidences,  in  many 
cases,  of  compensation  and  should  indicate  the  necessity 
for  a  careful  examination  of  the  structure  of  the  foot. 

In  the  attitude  of  rest  the  astragalus  rotates  slightly 
inward  and  downward  on  the  os  calcis,  thus  making  the 


352  PRINCIPLES  OF  OSTEOPATHY 

head  of  the  astragalus  somewhat  prominent  on  the  inner 
side  of  the  foot.  This  movement  is  checked  by  liga- 
ments, and  this  position  of  fixation  removes  all  strain  from 
the  muscles.  In  the  case  we  are  studying,  the  calcaneo- 
scaphoid  ligament  was  torn,  hence  the  rotation  of  the 
astragalus  is  limited  only  by  compressing  the  soft  tissues 
of  the  sole  against  the  floor,  as  is  evidenced  by  the  im- 
pression along  the  inner  border  of  the  foot  in  Fig.  150. 
The  position  of  the  head  of  the  astragalus  under  the 
scaphoid  raises  the  inner  border  of  the  foot  and  throws 
the  weight  on  the  outer  border,  a  natural  compensatory 
position.  From  the  foregoing  we  judge  that  this  foot  is 
a  poor  passive  support.  Although  it  has  done  good 
service  for  nearly  four  years,  it  has  never  been  called  upon, 
until  within  the  present  year,  to  act  for  long  periods  of 
time  as  a  passive  support.  Heretofore  this  foot  has 
adapted  itself  to  uneven  surfaces,  producing  constant 
variation  of  pressure.  Now  that  contact  with  smooth 
hard  pavement  gives  no  opportunity  for  shifting  of  weight 
and  alternating  contraction  of  muscles,  it  fails  as  a  sup- 
porting mechanism.  Steady  pressure  of  the  head  of  the 
astragalus  on  the  soft  tissues  of  the  plantar  surface  inter- 
feres with  circulation,  causes  edema  and  pain. 

The  secondary  function  of  the  foot  is  as  a  lever,  in 
actively  raising  and  propelling  the  body.  We  divide  these 
functions  into  primary  and  secondary,  because  a  foot  that 
might  serve  as  a  good  passive  support,  might  possess  none 
of  the  active  elements  required  in  running.  A  wooden 
foot  would  serve  as  a  support,  but  not  as  an  active  lever. 
The  heads  of  the  metatarsal  bones  act  as  a  fulcrum,  the 
calf  muscles  furnish  the  power,  the  weight  rests  on  the 
astragalus.  \Yhen  the  foot  is  used  normally,  the  line  of 
weight  passes  downward  through  the  center  of  the  knee 
and  ankle  joints,  hence  forward  along  the  line  of  the 
second  toe.  The  fact  that  the  inner  side  of  the  foot  is 
longer  than  the  outer,  causes  the  strain  resulting  from 
lifting  the  weight  of  the  body  over  the  fulcrum,  to  be  car- 


PRINCIPLES  OF  OSTEOPATHY  353 

ried  toward  the  outer  side  of  the  foot.  This  gives  an  ap- 
pearance of  turning  the  foot  inward — "pigeon-toe."  The 
toe  does  not  turn  in,  but  points  directly  ahead.  This  is 
the  normal  action  when  walking.  In  standing,  the  feet 
point  outward,  so  as  to  give  a  greater  base  of  support.  In 
walking  properly  the  feet  should  move  parallel  to  each 
other,  so  that  the  strain  falls  through  the  center  of  the  foot. 

The  movements  accomplished  by  the  case  we  are 
studying  were  quite  normal,  thus  demonstrating  that  all 
the  muscles  were  active,  and  that  there  was  very  little 
ankylosis  in  any  of  the  joints.  It  is  interesting  to  note 
that  the  astragalus  has  no  muscles  attached  to  it,  hence 
its  change  of  position  is  purely  accommodative.  All  the 
other  bones  of  the  tarsus  have  muscles  attached  to  them, 
hence  they  respond  to  muscular  contraction,  and  take  po- 
sitions to  which  the  astragalus  accommodates  itself  when 
weight  is  put  upon  it. 

An  interesting  problem  is  presented  in  this  case,  which 
is  associated  with  fractures  in  general.  We  have  been 
taught  that  fixation  is  the  basic  principle  in  the  treat- 
ment of  fractures,  and  this  is  so  firmly  believed  by  the 
public,  that  any  other  treatment,  which  might  be  used  by 
a  physician,  resulting  in  deformity  or  some  loss  of  func- 
tion, would  subject  the  physician  to  probable  loss,  in  a 
mal-practice  suit.  This  foot  never  had  the  benefits  of  rest, 
adjustment  of  the  bony  structure,  or  fixation.  It  passed 
through  the  successive  repair  stages,  subject  to  at  least  a 
moderate  degree  of  functional  demands.  How  much  bet- 
ter it  might  have  been  under  ordinary  routine  treatment, 
is  conjectural.  The  point  we  are  interested  in  at  this  time, 
is  the  adaptation,  which  has  resulted  in  a  fairly  useful 
foot  as  an  active  lever  under  conditions  of  rough  ground, 
but  has  failed  when  the  primary  function  of  passive  sup- 
port on  a  hard  level  surface  is  required. 


354  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  XVII. 

INHIBITION. 

Acceleration — Inhibition. — We  have  noted  in  a  former 
chapter  that  the  attributes  of  nervous  tissue  are  irritability, 
conductivity  and  trophicity.  We  may  add  to  these  ac- 
celeration and  inhibition.  We  do  not  use  the  terms  stimu- 
lation and  inhibition  as  denoting  opposite  conditions,  be- 
cause stimulation  applies  to  the  initiation  of  an  impulse. 
This  impulse  may  be  acceleratory  or  inhibitory  in  charac- 
ter. We  may  stimulate  a  nerve  whose  chief  function  is 
inhibition.  An  impulse,  whether  accleratory  or  inhibitory 
in  character,  is  the  result  of  stimulation. 

All  bodily  functions  require  stimulation,  in  the  sense 
we  have  used  the  term,  i.  e.,  something  must  initiate  an 
impulse  which  is  designed  to  excite  activity.  After  this 
activity  is  started,  it  must  be  governed.  It  is  the  means 
of  governing  these  activities,  we  are  interested  in  studying. 

Muscular  Contraction. — Muscle  may  be  s  imulated  to 
contraction.  This  contraction  may  be  increased  or  de- 
creased, thus  showing  that  after  initiatory  impulse  starts 
on  its  way  to  the  point  of  conversion  into  work  done  by 
the  muscle,  it  is  accelerated,  increased,  or  inhibited,  re- 
strained by  certain  influences  which  we  cannot  easily 
analyze.  The  contraction  and  relaxation  phenomena  of 
muscle  are  equally  important.  Vaso-constriction  and  vaso- 
dilation  are  examples  of  these  phenomena. 

Secretion. — The  activity  of  secretory  tissues  is  regu- 
lated by  some  arrangement  similar  to  that  controlling  mus- 
cular action.  After  a  cell  becomes  active,  it  is  still  under 


PRINCIPLES  OF  OSTEOPATHY  355 

the  control  of  a  governing  center,  which  accelerates  or 
inhibits,  according  to  the  necessities  of  the  case. 

Acceleration  and  Inhibition  as  Attributes  of  Nerve 
Tissue. — Cells  are  full  of  potential  energy,  which  needs  a 
stimulus  to  start  its  conversion  into  kinetic  energy.  We 
may  ask  ourselves  the  question ;  Why  isn't  all  of  the  po- 
tential energy  converted  into  kinetic  at  one  time,  or  in 
response  to  a  single  stimulus?  If  the  explosive  material 
in  a  magazine  is  ignited,  it  all  explodes — there  is  complete 
conversion  of  potential  into  kinetic  energy.  There  is  no 
restraining  or  accelerating  in  this  case.  The  element, 
nitrogen,  whose  liberation  in  this  case  causes  such  dire 
results,  is  the  same  element  in  the  cells  whose  liberation 
is  noted  as  "work"  done  by  muscle  or  gland.  Why  isn't 
all  the  nitrogen  in  the  cells  liberated  by  a  single  stimulus, 
as  in  the  magazine?  We  can  think  of  no  explanation  ex- 
cept that  impulses  passing  over  nerves  are  qualified  by 
other  impulses  passing  over  other  nerves,  the  two  stimuli 
of  opposite  character  thus  modifying  each  other,  or  in 
some  cases,  adding  their  forces  when  of  like  character. 

Inhibition  as  an  attribute  of  the  nervous  system,  does 
not  seem  to  be  exercised  in  short  reflex  arcs,  neither  does 
it  appear  to  be  exercised  by  centers  in  the  spinal  cord. 
It  may  be  that  a  certain  amount  of  inhibitory  influence 
is  exerted  in  these  subsidiary  centers,  but  thus  far  in- 
vestigations demonstrate  this  attribute  to  be  possessed  by 
the  brain  cells. 

Inhibition  a  Normal  Attribute  of  the  Central  Nervous 
System. — Inhibition  is  a  normal  restraining  influence  pos- 
sessed by  the  central  nervous  system.  When  the  osteo- 
pathic  physician  speaks  of  inhibition,  he  means  a  thera- 
peutic procedure  which  exercises  a  restraining  influence 
over  some  function,  this  restraining  influence  being  inde- 
pendent of  that  inhibition  which  is  an  attribute  of  the 
central  nervous  system. 

Anything  which  decreases  the  number  or  strength  of 
sensory  impulses  reaching  a  reflex  center,  is  inhibitory  in 


356  PRIXCIPLKS  OF  OSTEOPATHY 

character.  The  medical  profession  has  made  use  of  a  large 
number  of  agents  for  this  purpose,  opium,  for  example. 

History. — Inhibition  is  a  word  found  in  literature 
bearing  on  the  phenomena  of  the  nervous  system.  It  is 
well  for  us  to  investigate  the  history  of  this  word,  and 
the  phenomenon  which  it  indicates.  The  phenomenon 
which  occasioned  the  use  of  this  word  was  first  observed 
by  the  brothers  Weber  (1845)  and  many  investigators 
have  since  confirmed  it.  They  noted  that  excitation  of 
fibers  of  the  pneumogastric  nerve  occasioned  slowing  or 
stoppage  of  the  contractions  of  the  heart.  This  new  phe- 
nomenon must  have  a  designative  term,  hence  the  word 
"stoppage"  was  used,  meaning  the  arrest  of  activity  of 
an  organ,  by  arousing  activity  in  a  nerve  supplying  it.  The 
word  "inhibition"  was  proposed  later  by  Brown-Sequard 
and  has  remained  in  use,  to  the  exclusion  of  the  earlier 
terms. 

After  observing  the  phenomenon  of  nerve  arrest  in 
the  heart,  other  phenomena  of  a  somewhat  similar  charac- 
ter were  grouped  under  the  same  head.  Thus  we  find  the 
term  inhibition  confused  with  such  phenomena  as  the 
paralysis  of  motor  nerves  by  curare,  loss  of  sensation  fol- 
lowing the  inhalation  of  chloroform,  shock  and  fatigue. 
\\'e  can  thus  realize  the  great  confusion  of  meanings 
attached  to  this  term.  Later  investigators  realized  the 
essential  differences  in  these  phenomena,  and  drew  atten- 
tion to  the  fact  that  paralysis,  shock  and  fatigue  were  not 
comparable  to  the  phenomenon  of  arrest  of  cardiac  con- 
traction following  stimulation  of  the  pneumogastric. 
Morot  says,  "In  order  to  prevent  this  confusion,  it  is  neces- 
sary to  return  to  the  experimental  datum  which  lies  at  the 
foundation  of  the  conception  of  inhibition.  This  appella- 
tion will  be  given  to  every  phenomenon  reproducing  the 
characters  and  the  essential  conditions  of  stoppage  of  the 
heart  by  the  stimulation  of  the  vagus  nerves." 

Arrest  of  Activity. — Paralysis,  shock,  fatigue  and  in- 
hibition all  signify  arrest  of  activity,  but  are  not  synony- 


PRINCIPLES  OF  OSTEOPATHY  357 

mous,  as  may  be  noted  by  examining  into  the  pathology 
of  the  conditions  thus  described.  Paralysis  ordinarily 
means  arrest  of  activity,  due  to  a  destructive  process  in- 
volving nerve  elements. 

Shock. — Shock  is  a  phenomenon  more  closely  allied  to 
inhibition  than  the  others.  It  signifies  arrest  of  activity 
of  the  whole  nervous  system,  due  to  excessive  stimula- 
tion of  a  part,  as,  for  example,  the  making  of  a  wound. 
The  stimulation  produced  by  the  wound  reacts  on  the  cen- 
tral nervous  system,  and  produces  arrest  of  activity.  This 
phenomenon  fulfills  the  definition  of  inhibition,  as  it  is 
given  in  physiology:  "An  activity  which  prevents  the 
manifestation  of  other  activities." 

Fatigue. — Fatigue  is  the  arrest  of  activity  due  to  over 
stimulation,  and  therefore  involves  the  idea  of  destruction 
in  a  less  degree  than  is  signified  by  paralysis. 

Location  of  Inhibition. — In  the  consideration  of  re- 
flexes, we  presuppose  the  existence  of  a  mechanism  con- 
sisting of  two  nerve  elements,  motor  and  sensory.  The 
stimulation  of  the  latter  is  transmitted  to  the  former,  and 
is  manifested  by  work  done  by  the  terminal  tissue  which 
received  it.  This  simple  mechanism  presupposes  the  ap- 
proximation of  the  motor  and  sensory  elements  at  so'me 
central  point.  To  explain  inhibition,  we  must  add  a  third 
element  to  this  reflex  arc,  interposing  it  at  the  point  of 
contact  of  the  motor  and  sensory  elements.  Since  the 
point  of  terminal  contact  of  motor  and  sensory  elements 
is  in  the  gray  matter,  wherever  it  occurs,  this  inhibitory 
phenomenon  evidently  resides  in  the  same  location. 

Muscular  Activity. — It  is  axiomatic  that  muscular  ac- 
tivity is  the  evidence  of  the  nervous  elements  which  con- 
trol it.  Likewise,  it  has  been  considered  that  non-activity 
of  muscle  implied  quiescence  of  the  nervous  elements. 
The  phenomenon  of  inhibition  would  seem  to  imply  a 
form  of  activity  of  nervous  elements  just  as  important  as 


358  PRINCIPLES  OF  OSTEOPATHY 

that  which  calls  forth  contraction.  Muscular  repose  is  the 
result  of  nerve  activity.  This  is  the  important  point,  in  the 
practical  consideration  of  inhibition. 

Three  Characteristics  of  the  Nervous  System. — The 
nervous  system  during  its  developing  period,  shows  three 
special  characteristics,  i.  e.,  it  cither  appropriates  or  pro- 
duces energy — it  is  undetermined  how  the  energy  is  se- 
cured— transmits  energy,  and  lastly  retains  the  discharge 
of  energy.  The  last  characteristic  is  inhibition. 

Development  of  Inhibition. — "When  watching  the  move- 
ments of  a  young  babe,  we  are  amused  by  the  incoordinate 
activity  of  its  extremities.  At  this  stage  in  its  develop- 
ment, inhibition  is  not  an  accomplished  function  of  its 
nervous  system.  The  bladder  and  bowels  act  reflexly.  If 
inhibition  develops  normally,  the  child  soon  controls  de- 
fecation and  micturition  ;  if  not.  a  case  of  enuresis  exists, 
until  such  time  as  the  inhibitory  function  is  developed  in 
the  central  nervous  system. 

Neurotic  Diathesis,  Chorea. — The  w-ell  recognized  fact 
that  many  children  are  easily  precipitated  into  the  con- 
vulsive state,  is  an  evidence  of  the  poorly  developed  condi- 
tion of  this  third  attribute  of  nervous  tissues.  The  so- 
called  neurotic  diathesis  seems  to  mean  little  more  than 
faulty  development  of  inhibition.  Inhibition  may  develop 
in  a  fairly  normal  manner,  but  on  account  of  nutritional 
conditions,  environment  or  accident,  be  in  part  impaired. 
An  example  of  this  is  exhibited  by  the  well  known  un- 
controlled movements  in  chorea.  Impairment  of  the  in- 
hibitory function  of  the  central  nervous  system  would 
seem  to  be  sufficient  cause  for  chorea. 

Paralysis  Agitans. — To  carry  our  theory  into  later  life 
we  may  take  paralysis  agitans  as  an  example  of  the  im- 
pairment of  the  inhibitory  function  of  the  central  nervous 
system.  This  functional  neuronic  disease  presents  no  lesion 
of  the  nervous  tissue,  which  has  been  detected  up  to  the 


PRINCIPLES  OF  OSTEOPATHY  359 

present  time.  It  may  be  that  future  study  of  nerve  tissue 
will  discover  a  delicate  mechanism,  whose  purpose  is  in- 
hibition. 

Developing  Inhibition  by  Training. — The  functional 
activity  of  nerve  tissue  is  augmented  by  use,  just  as  muscu- 
lar power  is  enhanced  by  proper  training.  Knowing  this 
fact  is  evidenced  everywhere  in  the  field  of  educational 
endeavor,  we  feel  that  inhibition,  as  an  important  function 
of  the  nervous  system  (in  fact,  we  may  call  it  a  protec- 
tive function)  should  be  recognized  and  cultivated  early 
in  life.  The  well-trained  child  is  the  one  possessing  a 
well  balanced  nervous  system.  Such  a  child  does  not  have 
spasms,  because  appetite  and  desire  have  been  trained,  and 
these  virtues  of  self  control  manifest  themselves  in  nerve 
power  and  control.  Thus  do  we  find  the  consideration  of 
a  purely  scientific  aspect  of  the  development  of  the  nervous 
system  leads  us  into  thoughts  concerning  moral  develop- 
ment of  the  units  of  human  society.  Through  such  studies 
as  thi^,  the  physician  becomes  an  important  factor  in  the 
development  of  a  proper  and  healthful  social  life. 

Inhibitory  Effect  of  Pressure. — Now,  to  return  to  an- 
other view  of  our  subject,  we  call  your  attention  to  a  few 
of  the  recognized  phenomena  constantly  presented  to  us, 
by  our  efforts  to  alleviate  disease  conditions.  We  know 
by  many  experiences  that  by  pressure  on  the  surface  of 
the  body,  over  the  course  of  a  nerve  bundle,  a  restraining 
influence  is  often  exercised  over  the  function  of  the  tissue 
receiving  the  terminals  of  that  nerve  bundle.  Even  more 
interesting  is  the  observed  fact  that  a  restraining  influence 
is  often  exerted  on  tissues  remote  from  the  point  of  pres- 
sure, which  do  not  receive  any  of  the  terminals  of  the 
nerve  which  is  pressed  upon,  but  receive  terminals  of 
other  nerves  from  the  same  segment  of  the  central  nervous 
system.  We  may  even  go  farther  and  say  that  it  is  not 
an  unobserved  phenomenon  to  have  functional  activity 
restrained  in  very  remote  tissues,  which  do  not  seem 


360  PRINCIPLES  OF  OSTEOPATHY 

ordinarily  to  be  immediately  connected  with  the  segment 
of  nerve  tissue  directly  affected.  This  diffusion  of  re- 
straining influences,  following  external  pressure,  would 
seem  to  point  to  the  probability  that  the  pressure  acts  as 
a  stimulus  to  an  inhibitory  mechanism  in  the  central 
nervous  system.  If  this  were  not  so,  we  could  not  expect 
any  reflex  restraining  effects,  such  as  we  are  constantly 
seeking.  As  examples  of  pressure  effects,  let  us  call  at- 
tention to  pressure  of  the  suboccipital  nerves  in  cases  of 
headache.  These  nerves  are  in  position  to  be  compressed 
against  bone.  The  effect  of  compression  seems  to  be 
manifested  peripherally  by  a  decrease  in  pain.  Pain  in 
the  abdominal  viscera  can  frequently  be  lessened,  to  a 
very  appreciable  extent,  by  external  pressure  made  over 
the  proper  associated  spinal  area.  In  this  we  have  a  good 
example  of  the  reflex  effect  of  pressure,  which  seems  to 
uphold  the  idea  that  pressure  is  really  stimulation  of  a 
function  residing  in  the  central  nervous  tissues.  Pres- 
sure over  the  sacral  nerves  in  a  woman  passing  through 
the  menopause,  and  troubled  by  irregular  heart  action,  has 
been  known  to  be  almost  immediately  followed  by  reg- 
ular heart  rhythm.  Since  the  cardiac  irregularity  was  a 
reflex,  occasioned  by  disturbance  of  the  sacral  plexus,  there 
must  have  been  a  re-adjustment  of  nervous  activity,  due  to 
some  form  of  stimulation.  It  seems  very  probable  that  a 
movement,  which  we  name  inhibition,  may  in  reality  be 
a  form  of  stimulation  which  calls  forth  a  function  of  trie 
central  nervous  system,  the  resultant  action  of  the  cen- 
tral nervous  system  being  merely  evidence  of  the  fact  that 
re-adjustment  takes  place  as  a  self  preservative  activity, 
i.  e.,  a  manifestation  toward  the  normal. 

Dosage. — \Ye  are  likely  to  be  misled  into  the  fatuous 
belief  that  if  we  give  just  enough  stimulation,  or  inhibi- 
tion, in  a  given  case,  i.  e.,  if  our  dosage  is  just  right,  we 
will  get  perfect  results.  This  is  the  old  stumbling  block 
of  homeopathy  and  allopathy.  Devotees  of  these  systems 
beguile  themselves  with  the  idea  that  specificity  of  dosage 


PRINCIPLES  OF  OSTEOPATHY  361 

is  the  needful  thing.  If  we  observe  closely,  we  are  very 
cognizant  of  the  fact  that  we  can  not  exactly  estimate 
the  quantity  of  nerve  force  resident  in  the  patient  we 
are  treating.  This  being  so,  there  is  no  possibility  of 
exact  dosage,  hence  stimulation  and  inhibition,  as  thera- 
peutic measures,  other  than  simply  palliative  procedures, 
are  of  little  avail.  We  are  continually  impressed  with 
one  of  the  fundamental  ideas  in  osteopathic  practice,  that 
the  only  measurable  guiding  quantity  in  giving  an  osteo- 
pathic treatment  is  the  palpable  tissue  change,  the  lesion. 
Any  case  not  presenting  a  palpable  lesion,  can  only  be 
treated  on  general  principles  underlying  natural  therapeu- 
tics, i.  e.,  the  tonic  effect  of  change,  re-adjustment.  These 
changes  range  all  the  way  from  slight  variations  in  diet, 
habits,  surroundings  and  thoughts,  up  to  genuine  shock. 
Inhibition  as  a  form  of  movement  has  a  place  in  our  prac- 
tice, but  it  is  well  for  us  to  have  a  realizing  sense  of  its 
limitations. 

Impairment  of  Function. — Inhibition,  as  a  function  of 
the  central  nervous  system,  must  necessarily  impress  us 
with  a  host  of  new  ideas  in  connection  with  the  mani- 
festation of  lack  of  restraint  of  functional  activity  in 
various  tissues.  Enuresis  in  the  babe  is  normal,  but  we 
look  with  suspicion  on  its  presence  in  the  four  year  old; 
there  is  retardation  of  development.  Chorea  is  an  evi- 
dence of  impairment  of  this  function,  after  it  has  appar- 
ently been  normally  developed.  Paralysis  agitans  is  an 
evidence  of  impairment  of  this  function  late  in  life. 

Physiological  Activity  Is  the  Result  of  Stimulation. — 
All  the  functions  of  our  body  are  initiated  by  stimuli.  It 
must  not  be  inferred  from  this  statement  that  the  author 
is  satisfied  that  life  consists  of  nothing  but  reflexes.  So  far 
as  we  can  note  the  phenomena  of  muscle  and  gland,  we  are 
compelled  to  recognize  the  fact  that  most  of  them  are  re- 
flexes. Work  done  by  muscle  and  gland  is  initiated  prin- 
cipally by  sensory  stimuli.  Excessive  sensory  stimuli  excite 


362  PRINCIPLES  OF  OSTEOPATHY 

increased  work  in  muscle  and  gland,  sometimes  to  the  point 
of  exhaustion.  To  decrease  the  amount  of  work,  we  must 
decrease  the  number  of  stimuli.  The  stimuli  originate  at  the 
periphery  of  sensory  nerves.  Sensory  nerves  are  most 
numerous  in  the  skin,  mucous  membrane  and  muscle.  Inhib- 
itory influences  must  be  applied  to  one  or  more  of  these 
structures.  Skin  is  the  surface  tissue,  richly  supplied  by 
sensory  nerves,  and  under  it  are  muscles,  also  well  sup- 
plied by  sensory  nerves. 

Hilton's  Law. — Hilton,  by  showing  that  the  skin,  mus- 
cles and  synovial  membrane  of  a  joint,  or  the  skin,  mus- 
cles of  the  abdomen  and  contents  covered  by  peritoneum, 
are  innervated  from  the  same  segment  of  the  cord,  laid  a 
foundation  for  the  rational  use  of  inhibition,  in  osteopathic 
practice. 

Inhibition — Therapeutic. — Inhibition,  as  a  terapeutic 
procedure,  consists  in  a  steady  digital  pressure  made  over 
some  nerve  trunk,  or  over  an  area  which  is  closely  con- 
nected with  a  spinal  segment  from  which  nerves  pass  to 
an  internal  viscus,  which  we  desire  to  affect. 

In  order  to  explain  the  necessity  for  this  movement 
and  its  beneficial  effects,  we  must  note  the  phenomena  of 
vaso-motion. 

How  Vaso-motor  Centers  Act. — Vaso-motor  centers 
act  according  to  the  sum  of  the  stimuli  reaching  them 
from  skin,  muscle,  glands,  etc.  If  the  sensory  nerves  of 
one  lateral  half  of  the  body  are  stimulated,  as  by  pricking 
with  needles,  the  temperature  of  that  half  of  the  body 
will  be  higher  than  the  other,  thus  demonstrating  that 
excessive  stimulation  of  sensory  nerves  ends  in  vaso- 
dilation.  i.  e.,  loss  of  tone  of  the  muscular  coat  of  the  blood 
vessels.  Since  excessive,  i.  e.,  over-stimulation  of  sensory 
nerves  in  this  experiment  causes  inhibition  of  vascular 
tone  and  hyperaemia  results,  we  argue  that  any  procedure, 
which  lessens  the  excessive  amount  of  stimulation  pass- 
ing to  a  vaso-motor  center,  will  favor  the  return  of  the 
vascular  tone.  Therefore,  since  it  is  easily  demonstrated 


PRINCIPLES  OF  OSTEOPATHY  363 

that  digital  pressure  lessens  pain  and  sensitiveness  in  the 
area  pressed  upon,  we  know  that  the  registering  power  of 
these  peripheral  nerves  is  decreased,  and  there  results  a 
better  vascular  tone  in  that  area. 

Over-stimulation  Equals  Inhibition. — If  over-stimula- 
tion results  in  inhibition  of  vascular  tone,  as  the  above  ex- 
periment seems  to  demonstrate,  then  it  appears  rational  to 
decrease  the  stimulation  to  a  point  where  vascular  tone 
is  not  disturbed.  Digital  pressure  does  decrease  the  ir- 
ritability; therefore  we  may  express  ourselves  as  follows: 
Inhibition  of  sensory  nerves,  in  skin  and  muscle,  which 
are  over-stimulated,  will  favor  the  return  of  vascular  tone 
in  all  areas  which  are  supplied  with  nerves  from  the  same 
segment  of  the  cord. 

Over-stimulation  of  sensory  nerves  causes  vascular 
dilatation.  Inhibition  lessens  the  irritability  of  sensory 
nerves  and  hence  decreases  the  number  of  stimuli  reach- 
ing the  vaso-motor  centers,  thus  allowing  a  return  of  vas- 
cular tone. 

The  Guide  for  the  Use  of  Inhibition. — Knowing  the 
complete  distribution  of  any  nerve  trunk,  we  may  judge 
the  condition  of  the  internal  structures,  supplied  by  one 
of  its  branches,  by  the  physiological  activity  of  surface 
tissues,  supplied  by  others  of  its  branches.  In  this  way 
we  are  guided  as  to  our  use  of  inhibition. 

Pathological  Changes  Which  Accompany  Over-stimu- 
lation.— If  an  individual  eats  a  hearty  meal,  and  before  it  is 
digested  eats  another,  and  continues  the  process,  the  stimu- 
lation of  the  sensory  nerves  in  the  mucosa  of  his  digestive 
viscera  results  in  a  physiological  hyperaemia  which,  under 
the  ceaseless  stimulation  of  the  presence  of  food,  finally 
becomes  chronic.  The  liver  becomes  hyperaemic,  and  its 
sensory  nerves  are  stimulated  by  the  increased  amount  of 
blood  present  in  the  capillaries.  These  sensory  nerves 
do  not  register  their  impressions  on  the  sensorium  of  the 
brain,  but  do  excite  that  area  of  the  spinal  cord  with  which 
they  are  connected  by  means  of  the  rami-communicantes. 


364  PRINCIPLES  OF  OSTEOPATHY 

This  area  of  the  spinal  cord  lies  between  the  sixth  and 
tenth  dorsal  spines.  From  this  area,  nerves  pass  to  the 
deep  muscles  of  the  back.  These  muscles  are  excited  to 
undue  contraction,  and  their  sensory  nerves  are  thereby 
made  sensitive.  The  capillary  circulation  in  these  muscles 
is  poor,  thereby  increasing  the  muscular  sensitiveness. 
This  muscular  sensitiveness,  or  rather  increased  stimula- 
tion of  the  sensory  endings  in  the  muscles,  sends  a  new 
set  of  impulses  to  the  same  area  of  the  spinal  cord,  sixth 
to  the  tenth  dorsal,  and  the  cord  reflexes  them  back  to  the 
sympathetic  system.  Thus  a  figure  8  is  formed  with  the 
union  of  the  circles  representing  the  spinal  cord.  With 
impulses  entering  the  cord  from  both  loops,  sympathetic 
and  cerebro-spinal,  the  cord  itself  becomes  hyperaemic. 
The  constant  interchange  of  reflexes  which  were  originated 
by  excessive  demands  on  the  physiological  activity  of  the 
tissues  involved,  either  ends  in  a  spasmodic  effort  of  na- 
ture to  rid  itself  of  the  intolerable  condition,  by  means  of 
a  "bilious  spell,"  or  the  hyperaemia  causes  excessive  secre- 
tion of  mucous,  hypertrophy  of  connective  tissue,  and 
atrophy  of  parenchymatous  tissue.  The  bilious  spell  is 
nature's  safety  valve. 

Rational  Treatment. — After  such  a  condition  as  we 
have  described  is  well  established,  dieting  merely  lessens 
the  reflexes  in  the  sympathetic  portion  of  our  figure  8. 
The  reflexes  in  the  cerebro-spinal  portion  are  still  active, 
because  the  deep  muscles  of  the  back  have  become  chron- 
ically contracted,  and  continue  to  over-stimulate  the  sen- 
sory nerves.  These  cerebro-spinal  reflexes  still  help  to 
maintain  the  hyperaemia  of  the  spinal  cord,  which  con- 
tinues to  disturb  the  rhythm  of  the  sympathetic.  Mani- 
festly, the  treatment  must  consider  both  portions  of  the 
figure  8.  Dietetics  will  lessen  to  some  extent  the  hyper- 
activity  of  the  sympathetic  loop.  Digital  pressure,  inhibi- 
tion, will  relax  the  spinal  muscles,  and  lessen  the  hyper- 
activity  of  the  cerebro-spinal  loop.  The  two  lines  of  treat- 
ment will  decrease  the  number  of  stimuli  entering  the 


PRINCIPLES  OF  OSTEOPATHY  365 

segment  of  the  spinal  cord,  sixth  to  tenth  dorsal,  hence 
there  will  cease  to  go  out  from  that  segment  a  series  of 
impulses  which  have  tended  to  pervert  the  secretion  in 
the  digestive  viscera. 

The  contraction  of  the  spinal  muscles  may  have  sub- 
luxated  a  vertebra  which  then  becomes  a  source  of  irrita- 
tion. In  such  a  case,  a  movement  to  replace  the  vertebra 
in  its  true  relation  acts  in  the  nature  of  inhibition,  i.  e., 
it  ceases  to  cause  excessive  stimuli  to  enter  the  spinal  cord. 

Digital  pressure  on  contracted  dorsal  muscles  causes 
sensitiveness,  i.  e.,  consciousness  of  the  fact  that  the  nerves 
in  that  region  are  abnormally  irritable.  The  sensitive 
area  along  the  spine  will  be  in  direct  central  connection 
with  an  internal  viscus  which  is  equally  if  not  more 
sensitive. 

Hyperaesthesia  of  Sensory  Areas — Diagnosis. — The 
hyperaesthesia  of  sensory  areas  along  the  spine  is  of  prac- 
tical value  for  diagnostic  and  therapeutic  purposes  when 
we  know  their  nerve  connections.  By  inhibiting  a  hyper- 
sensitive spinal  area,  we  set  up  a  change  in  an  area  of  low 
sensibility,  i.  e.,  a  visceral  area.  The  inhibitory  pressure 
does  not  merely  deceive  consciousness  by  lessening  the 
power  of  its  informing  nerves,  which  alone  have  power  to 
stir  up  those  reflexes  which  will  tend  to  assist  the  dis- 
eased part  to  return  to  normal. 

Results  of  Inhibition. — We  know  that  inhibition  les- 
sens pain  in  the  area  of  conscious  sensation.  The  result 
of  daily  practice  teaches  us  this. 

Inhibition  of  painful  areas  does  more  than  lessen 
pain ;  it  aborts  those  impulses  which  are  the  result  of  pain, 
and  sends  a  counter  impulse  into  the  center  which,  in  a 
measure,  negatives  the  original  impulse.  If  this  were 
not  so.  we  could  not  stop  vomiting,  intestinal  peristalsis 
or  uterine  colic.  We  know  that  inhibition  of  a  sensory 
area  of  the  spine  not  only  stops  pain  in  that  area,  but 
also  pain,  if  there  is  any,  in  the  viscus  which  is  in  central 


366  PRINCIPLES  OF  OSTEOPATHY 

connection  with  it.  Therefore,  if  we  affect  the  tonus  of 
both  skeletal  and  involuntary  muscles,  sensation  in  the 
cerebro-spinal  and  sympathetic  systems,  we  certainly  af- 
fect the  caliber  of  blood  vessels  and  the  activity  of  secre- 
tory and  excretory  glands. 

It  is  not  too  much  to  say  that  inhibition  does  not  de- 
ceive consciousness  by  lessening"  the  power  of  registering 
nerves,  but  does  stop  a  storm  of  reflexes  which  have  no 
reparative  tendency,  and  that  it  does  affect  the  area  of  low 
sensibility,  as  is  evidenced  by  a  change  in  the  condition 
of  its  musculature,  blood  supply  and  secretory  activity. 

There  are  many  osteopaths  who  contend  that  the  key- 
note of  all  manipulative  work,  according  to  osteopathic 
principles,  is  the  discovery  and  removal  of  a  "lesion," 
osseous  in  character.  With  this  idea  carried  to  extreme, 
the  author  has  no  sympathy.  In  connection  with  this 
idea  the  student  is  referred  to  the  chapter  on  Subluxation, 
page  283. 

The  Phrase  "Remove  Lesions." — The  phrase  "Remove 
Lesions"  is  a  good  one,  and  yet  it  is  inexact  in  many 
cases.  It  is  an  elastic  phrase,  and  capable  of  many  and 
varied  interpretations.  Each  year  of  active  practice  adds 
to  the  osteopathic  idea  of  what  lesions  are.  Our  litera- 
ture contains  many  references  to  lesions  which  are  not 
mentioned  in  Dr.  Still's  writings,  and  yet  Dr.  Still's  basic 
work  has  made  the  later  conception  possible.  Osseous 
lesions  have  always  been  paramount  in  our  work  and 
thought,  but  muscular  lesions  now  hold  an  equal  place, 
and  bid  fair  to  lead,  when  we  see  more  clearly  into  the 
subject. 

The  Human  Body  Is  a  Vital  Mechanism. — We  say 
that  "when  the  anatomical  is  absolutely  correct,  the  physi- 
ological potentiates."  This  conception  is  based  on  the 
statement  that  the  human  body  is  a  machine.  The  human 
body  is  vastly  more  than  a  machine.  It  is  a  vital  mech- 
anism, and  the  fact  that  it  is  vital,  renders  it  susceptible 
to  other  influences  besides  mechanical,  such  as  falls,  twists, 


PRINCIPLES  OF  OSTEOPATHY  367 

strains,  etc.  We  may  truthfully  say  that  when  the 
physiological  is  over-active,  the  anatomical  alignment  is 
disarranged.  The  principles  of  osteopathy,  as  they  were 
first  promulgated,  declared  that  a  structural  defect  is  at 
the  bottom  of  every  physiological  defect.  Structure  al- 
ways affects  function.  A  sufficient  number  of  cases  were 
found  to  give  a  foundation  of  fact  to  this  statement. 
Hasty  reasoning  tried  to  make  this  an  all-embracing  prin- 
ciple, applicable  to  every  case  of  disease.  Other  schools 
of  medicine  have  made  similar  mistakes.  The  allopathic 
school  promulgated  the  "law  of  contraries."  The  homeo- 
pathic school  holds  aloft  the  "law  of  similars."  Neither 
of  these  are  laws.  A  law  is  absolute,  no  exceptions  are 
tolerated.  If  there  are  any  exceptions  to  a  so-called  law, 
it  ceases  to  be  a  law. 

Osteopathic  Meaning  of  Inhibition. — By  the  term  in- 
hibition, we  do  not  attempt  to  convey  any  other  meaning 
than  that  of  pressure,  applied  at  some  particular  point  on 
the  surface  of  the  body,  for  the  purpose  of  lessening  the 
hyperactivity,  or  hyperaesthesia,  of  the  immediate,  or  some 
distant  part  of  the  body.  The  inhibition  itself  does  in  some 
cases  remove  what  we  may  choose  to  call  a  lesion,  in  other 
cases  it  may  make  the  removal  of  a  lesion  possible,  but 
in  the  majority  of  cases,  its  effect  is  purely  on  the  nerves, 
thereby  acting  on  both  the  motor  and  sensory  portions 
of  the  reflex  arc,  lessening  muscular  contraction  and  pain. 

The  Scientific  Use  of  Inhibition. — It  has  been  proven 
many  times  that  the  osteopath  is  capable  of  checking  ex- 
cessive functional  activity  in  viscera  by  the  simple  means 
of  inhibition.  Some  would  quibble  as  to  the  cause  of  this 
activity.  The  original  stimulus  may  have  disappeared, 
but  the  reflexes  which  it  initiated  may  be  perpetuating 
the  condition.  Many  cases  have  been  treated  in  which  no 
definite  cause  or  osseous  lesion  could  be  discovered.  Some 
of  these  cases  came  under  the  heading  Indiscretions;  others 
under  purely  mental  conditions.  These  cases  were  treated 


368  PRINCIPLES  OF  OSTEOPATHY 

by  inhibition,  based  on  a  knowledge  of  the  anatomy  and 
physiology  of  the  parts  involved.  The  treatment  was 
successful.  \Yc  are  sure  that  such  successes  are  just  as 
gratifying,  just  as  scientific,  as  are  those  in  which  the  find- 
ing and  reducing  of  a  subluxation  brings  the  glow  of  tri- 
umph to  the  eye  of  patient  and  physician  alike. 

Inhibition  as  a  Local  Anaesthetic. — Inhibition  is  a  local 
anaesthetic,  and  as  such,  is  being  used  universally  in  the 
osteopathic  profession  today.  True,  it  is  not  a  treatment 
which  will  secure  results  in  a  minute.  We  can  not  in- 
hibit for  five  minutes  at  the  eighth  dorsal  spine,  in  a  case 
of  malarial  fever,  and  expect  to  check  the  chill.  The  chill 
can  sometimes  be  controlled  as  long  as  the  inhibition  is 
maintained.  The  influence  thus  gained  over  the  muscular 
contractions  seems  to  increase  the  patient's  resistance. 
The  onset  of  the  next  chill  usually  shows  a  decrease  in 
the  intensity  of  muscular  contraction,  and  the  duration 
is  shortened.  No  one  would  say  that  we  remove  a  physical 
lesion  by  this  treatment,  or  the  cause  of  the  chill.  Mus- 
cular contraction  of  the  deep  dorsal  muscles  comes  on 
with  the  chill,  but  does  not  cause  it.  Surely  inhibition  in 
this  case  works  a  nervous  change  of  a  pronounced  char- 
acter. 

An  example  of  the  good  results  of  inhibition  is  af- 
forded by  one  of  the  author's  cases.  \Yoman,  fifty  years 
of  age,  suffered  from  diarrhoea,  two  years'  duration.  Five 
to  seven  bowel  movements  daily.  Xo  formed  feces. 
Usually  the  stools  were  typhoid  in  character.  Uterine 
fibroid  removed  prior  to  development  of  diarrhoea.  His- 
tory of  continuous  drug  treatment.  Osteopathic  examina- 
tion did  not  reveal  any  osseous  lesion.  There  seemed  to 
be  nothing  to  lay  the  blame  upon,  except  the  once  existent 
fibroid,  or  the  result  of  the  operation.  Since  no  definite 
lesion  existed,  the  treatment  was  planned  as  a  test  of  in- 
hibition without  any  other  method.  At  the  end  of  three 
months  the  patient  had  but  one  movement  daily,  and  the 


PRINCIPLES  OF  OSTEOPATHY  369 

feces  were  well  formed.  Pressure,  and  gentle  stretching 
of  the  muscles  extending  over  the  area  between  the  eighth 
dorsal  and  fifth  lumbar  spines,  constituted  the  methods 
used.  From  fifteen  to  twenty  minutes  was  the  duration  of 
the  treatment,  three  times  per  week  for  two  months,  and 
twice  per  week  thereafter. 

In  cholelithiasis  the  intense  pain  can  be  modified  by 
inhibition  at  ninth  and  tenth  dorsal  spines,  right  side.  In- 
hibition at  this  point  also  lessens  the  contraction  of  the 
abdominal  muscles,  and  thus  makes  direct  manipulative 
treatment  possible.  The  same  is  true  in  cases  of  appen- 
dicitis. We  could  not  give  direct  manipulative  treatment 
in  such  cases,  if  it  were  not  for  the  power  of  inhibition  to 
lessen  pain  in  the  affected  area,  and  the  consequent  mus- 
cular contraction.  How  much  more  influence  is  exerted 
over  the  nerves  of  the  appendix  and  surrounding  region,  it 
is  hard  to  say.  It  may  be  that  the  inhibition  arouses  other 
forces  of  a  stimulatory  character  to  be  brought  into  action 
to  empty  the  appendix.  Direct  manipulation  in  these  cases 
is  frequently  out  of  the  question. 

Inhibition  to  Remove  Lesions. — Inhibition  is  a  large 
and  necessary  part  of  many  treatments  given  for  the  pur- 
pose of  removing  a  definite  lesion,  for  if  inhibition  were 
not  first  used,  the  true  lesion  could  not  be  touched.  This 
is  the  case  in  intestinal  obstructions.  The  intestinal  irrita- 
tion causes  such  bowel  contractions,  cramps,  and  con- 
traction of  the  abdominal  muscles,  that  the  physician's 
fingers  cannot  palpate  the  disturbed  area.  Inhibition  over 
the  spinal  area  from  which  the  nerves  to  the  disturbed 
area  pass  out,  will  cause  relaxation  of  the  muscles. 

In  a  case  of  pleurisy  which  came  under  the  author's 
care,  an  opportunity  was  afforded  to  test  inhibition  un- 
hampered by  any  other  method.  The  patient  could  not 
bear  to  have  the  right  arm  moved ;  respiration  was  exceed- 
ingly shallow,  and  the  physical  strength  was  very  low. 
Hot  fomentations  had  been  used,  but  to  lift  the  arm  caused 


370  PRINCIPLES  OF  OSTEOPATHY 

excruciating  pain  in  the  side.  It  was  a  case  of  dry  pleu- 
risy. Steady  inhibition  was  given  for  fifteen  minutes,  be- 
tween the  transverse  processes  on  the  right  side,  in  the 
area  between  the  third  and  the  seventh  dorsal  vertebrae. 
After  this  length  of  time  the  patient  could  raise  the  right 
arm  above  the  head  and  take  much  better  inspiration.  As 
a  result  of  this  treatment  given  twice  per  day,  the  patient 
made  a  good  recovery,  though  all  the  metabolic  processes 
were  carried  on  in  a  very  unsatisfactory  way. 

Inhibition  as  a  Preparatory  Treatment. — There  is  still 
another  time  when  inhibition  is  of  incalculable  value :  In 
making  examination  of  the  vagina  or  rectum,  especially 
the  former.  Several  times,  in  the  author's  practice,  exam- 
ination of  the  vagina  seemed  impossible,  without  great  dis- 
tress to  the  patient.  The  irritability  of  the  mucous  mem- 
brane of  the  vagina  caused  intense  spasmodic  contraction 
of  the  sphincter,  but  steady  inhibition  over  the  third  and 
fourth  sacral  foramina  for  about  five  minutes,  caused  com- 
plete relaxation,  and  the  examination  could  then  be  made 
without  any  trouble.  Cases  have  been  reported  to  the 
author  by  many  osteopaths,  describing  the  good  results  of 
inhibition  in  gynecological  cases.  These  cases  have  ranged 
from  simple  nervous  vaginismus  to  curettement.  Since 
the  sacral  nerves  are  so  near  the  surface,  and  are  not  in- 
terrupted in  their  course  to  the  pelvic  viscera,  they  afford 
excellent  opportunity  for  the  good  effects  of  inhibition  to 
be  demonstrated. 


PRINCIPLES  OF  OSTEOPATHY  371 


CHAPTER  XVIII. 

SOUNDS  PRODUCED  IN  JOINTS  BY  MANIPULA- 
TION. 

Normal  Sounds. — It  is  not  uncommon  to  hear  peculiar 
sounds  accompanying  the  normal  movement  of  joints.  These 
sounds  are  indicated  by  popular  terms,  such  as  "cracking," 
"snapping"  and  "popping."  They  are  so  common  that  every 
one  has  heard  them,  either  in  their  own  bodies,  or  those  of 
friends.  Pulling  the  fingers  is  the  best  known  method.  It  is 
commonly  supposed  that  such  a  method,  if  persisted  in,  will 
enlarge  the  joints.  It  is  doubtful  whether  there  is  any  proof 
of  this.  Doubtless  the  fear  of  it  originated  as  an  effort  to 
frighten  some  one  in  whom  the  phenomenon  was  easily  pro- 
duced. Loose  jointed  people  are  able  to  produce  sounds  in 
many  joints  by  carrying  normal  movements  to  the  limit. 
Scarcely  any  movable  joint,  in  which  the  ligaments  and 
muscles  are  normally  relaxed,  is  free  from  the  possibility  of 
producing  sound,  when  the  opposing  muscles  are  contracted 
unevenly,  i.  e.,  either  the  flexors  or  extensors  predominating. 
The  joint  surfaces  will  slip  upon  each  other  suddenly,  thus 
producing  the  sound.  After  it  has  been  once  made,  it  is 
rarely  repeated  without  there  has  been  an  interval  of  rest, 
during  which  the  muscles  change  their  tension.  The  crack- 
ing in  the  tempero-maxillary  articulation  can  be  repeated 
until  the  structures  ache,  because  it  is  occasioned  by  the  slid- 
ing of  the  interarticular  cartilage  on  to  the  eminentia  articu- 
laris.  The  wrist  and  shoulder  are  capable  of  producing  fre- 
quent sounds,  on  account  of  their  free  movement,  and  the 
many  directions  in  which  the  force  is  applied. 


372  PRINCIPLES  OF  OSTEOPATHY 

Abnormal  Sounds. — A  large  number  of  sounds  which 
originate  in  joints  are  abnormal ;  i.  e.,  the  joints  are  not 
normal,  or  else  these  particular  sounds  would  not  be  pro- 
duced. Some  of  these  sounds  are  familiar  to  all  physicians. 
They  result  from  forced  motion,  actively  or  passively  made, 
in  a  joint  having  limited  movement  as  a  result  of  injury;  or 
intracapsular  deposits,  due  to  disease.  Another  class  of 
sounds  is  produced  by  forced  movement,  passive,  in  joints 
having  lost  some  of  the  normal  relations  of  their  surfaces. 

Pathology  of  Joints  Producing  Abnormal  Sounds. — It 
may  be  well  to  recount  systematically  the  conditions  in 
which  passive  movement  of  joints  produces  sounds.  In  this 
way  we  can  note  the  difference  between  the  characters  of 
sounds  usually  recognized  by  physicians,  and  those  especial- 
ly peculiar  to  manipulative  treatment  of  subluxations. 

Synovial  Adhesions. — The  breaking  of  adhesions  be- 
tween articular  surfaces  produces  a  sound  comparable  to 
that  occasioned  by  the  breaking  of  a  green  stick,  in  which 
the  fibers  break  individually  as  the  force  becomes  greater 
and  greater.  Synovial  adhesions  are  due  to  many  causes, 
the  simplest  of  which  are  slight  injury  and  non-use  of  a 
joint.  An  injury  sufficient  to  cause  slight  efforts  at  repair, 
when  accompanied  by  rest,  will  result  in  a  few  adhesions. 
Voluntary  movement  of  the  joint  is  arrested  by  these  adhe- 
sions. Such  conditions  frequently  follow  a  sprain,  or  the 
splinting  of  a  joint  just  above  or  below  a  fracture.  The  joint 
may  be  quite  well,  but  by  keeping  it  perfectly  fixed  during 
the  repair  of  the  fracture,  the  periarticular  structures  lose 
their  elasticity,  and  a  few  adhesions  mav  form  within. 

Non-use  of  a  Slightly  Sprained  Joint. — Sometimes  a 
timid  person  may  be  so  fearful  of  moving  a  slightly  sprained 
joint  that  adhesions  form,  and  control  of  the  joint  is  lost.  I 
was  recently  called  to  examine  a  foot,  which  was  very  pain- 
ful and  useless.  Seven  months  previously  the  ankle  was 
sprained.  The  foot  had  not  been  used  since  that  injury.  I 
found  the  foot  stiff,  cold  and  resting  on  a  pillow.  Examina- 
tion revealed  slight  motion  which  seemed  to  be  limited  by 


PRINCIPLES  OF  OSTEOPATHY  373 

elastic  bands.  There  was  no  inflammation  in  the  foot.  Sud- 
den force,  applied  first  in  direction  of  flexion,  then  extension, 
caused  a  series  of  cracking  sounds,  which  indicated  the  rup- 
turing of  adhesions.  The  range  of  motion  instantly  in- 
creased. If  these  adhesions  had  been  broken  six  months  be- 
fore, much  of  the  muscular  atrophy  of  the  leg  and  thigh 
would  have  been  avoided. 

A  patient  with  broken  femur,  having  been  kept  in  bed 
twelve  weeks,  was  unable  to  move  the  knee,  on  account  of 
adhesions  formed  during  period  of  non-action  due  to  splint- 
ing. Forcible  flexion  of  the  knee  a  little  each  day  gradually 
broke  the  adhesions,  until  movement  was  nearly  normal. 

These  are  the  cases  with  which  all  physicians  are  fa- 
miliar. The  sounds  produced  are  not  repeated  at  any  time 
following  the  first  forcible  movements.  Such  adhesions  as 
these,  are  due  to  rest,  not  without  some  slight  injury,  involv- 
ing the  joint  structures.  I  do  not  believe  that  non-use  alone 
is  capable  of  causing  adhesions. 

Rheumatic  Joints. — Rheumatic  joints  sometimes  mani- 
fest conditions  similar  to  sprain.  Adhesions  form  during 
the  period  of  inflammation  and  persist  after  its  subsidence. 
Rupturing  these  by  sudden  force  frequently  restores  normal 
movement. 

All  the  foregoing  conditions  are  the  result  of  some  de- 
gree of  inflammation.  Forced  movement  breaks  the  adhe- 
sion, which  makes  a  sound  as  it  breaks.  There  is  no  repeti- 
tion of  the  sound  in  succeeding  movements. 

Semilunar  Cartilages  of  the  Knee. — The  semilunar 
cartilages  of  the  knee  joint  may  become  displaced  and  cause 
great  pain,  with  loss  of  motion.  A  case  recently  under  treat- 
ment gave  history  of  frequent  accidents  of  this  kind,  while 
riding  a  bicycle.  When  extending  the  leg  to  push  the  pedal 
down,  the  force  was  exerted  with  the  knee  somewhat 
everted.  Excruciating  pain  came  on  suddenly,  and  the  leg 
could  not  be  extended.  Examination  revealed  a  very  sen- 
sitive spot  at  the  outer  and  anterior  surface  of  the  joint.  The 
semilunar  cartilage  slipped  forward  and  blocked  the  exten- 


374  PRINCIPLES  OF  OSTEOPATHY 

sion  of  the  joint.  By  taking  the  leg  between  my  knees  and 
making  thumb  pressure  on  the  painful  prominent  spot,  then 
gently  flexing  and  slightly  rotating  the  tibia  on  the  condyles 
of  the  femur,  followed  by  quick  extension,  a  distinct  sound 
was  elicited,  and  the  action  of  the  joint  was  restored.  The 
sound  indicated  replacement  of  the  cartilage. 

"Bone  Setting." — It  has  been  supposed  that  much  of 
the  work  of  osteopaths  consisted  in  breaking  adhesions, 
which  were  simple  enough,  but  happened  not  to  have  been 
strictly  attended  to  by  the  surgeons.  There  is  much  chance 
to  misinterpret  the  work  of  the  osteopaths  in  reducing  sub- 
luxations.  Medical  men  of  established  schools  of  medicine 
have  failed  to  closely  analyze  the  structural  condition  of 
joints  before  and  after  manipulation,  hence  they  have  jumped 
to  the  conclusion  that  all  of  our  work  was  of  that  kind  called 
"bone  setting"  for  want  of  a  better  descriptive  term.  This 
appellation,  "bone  setting,"  is  a  popular  one,  first  used  in 
England  to  describe  the  work  of  individuals,  usually  un- 
educated, who  treated  patients  by  manipulation  of  joints, 
which  they  said  were  out.  Quick  forceful  movements  in  the 
direction  of  normal  joint  actions  usually  resulted  in  a  "pop- 
ping" sound.  When  this  occurred  the  "bone  setter"  consid- 
ered his  work  accomplished. 

Historical  Reference. — Aside  from  adhesions  the  condi- 
tions which  we  find  limiting  the  movements  of  joints  are 
subluxations.  Wharton  P.  Hood,  M.D.,  M.R.C.S.,  furnished 
the  Lancet  a  description  of  what  was  commonly  called 
"bone  setting."  His  articles  were  published  in  that  journal 
March  and  April,  1871.  The  articles  were  published  in  book 
form  the  same  year,  entitled  "On  Bone  Setting  (So  Called) 
and  Its  Relation  to  the  Treatment  of  Joints  Crippled  by  In- 
jury, Rheumatism,  Inflammation,  Etc."  Dr.  Hood  made 
close  observations  of  the  work  of  a  ''bone  setter" — Mr.  Hut- 
ton.  This  gentleman  sought  to  teach  Dr.  Hood  his  art,  as  a 
matter  of  gratitude  for  professional  attention  given  him  by 
Dr.  Peter  Hood.  In  the  pages  of  this  book  I  find  a  clear, 
concise  exposition  of  the  bone  setter's  art,  together  with  a 


PRINCIPLES  OF  OSTEOPATHY  375 

record  of  the  observations  of  the  author,  who  has  the  advan- 
tage of  excellent  training  in  the  medical  arts.  There  is  no 
doubt  in  my  mind  as  to  the  similarity  existing  between  the 
conditions  which  were  recognized  by  so-called  "bone  setters" 
and  those  who  have  formed  the  basis  for  the  successful  ad- 
vancement of  osteopathy.  The  difference  lies  principally  in 
the  educational  qualifications.  Dr.  Hood  notes  that  the  man- 
ipulations were  made  without  any  knowledge  of  anatomy  and 
physiology,  but  were  nevertheless  astonishingly  successful, 
and  he  calls  attention  to  the  fact  that  much  greater  success, 
with  less  probability  of  injury,  ought  to  result  from  these 
manipulations,  when  the  true  pathology  of  the  joint  is  under- 
stood; i.  e.,  when  the  operator  is  in  fact  a  trained  surgeon, 
thoroughly  versed  in  the  details  of  anatomy.  Dr.  Hood  evi- 
dently did  not  understand  the  conditions  which  we  recog- 
nize as  subluxations  of  the  ribs  and  vertebrae,  although  he 
came  very  near  to  it,  as  you  will  observe  hereafter.  His  at- 
tention was  principally  fixed  on  the  conditions  following 
greater  or  lesser  degrees  of  joint  inflammation,  resulting  in 
intra-articular  adhesions  or  extra-articular  contractions.  In 
the  case  of  adhesions,  breaking  them  causes  a  sound  which 
can  not  be  repeated,  but  subluxations  may  occur  repeatedly 
in  the  same  joint,  each  reduction  causing  a  sound. 

Tarsal  and  Carpal  Subluxations. — In  Dr.  Hood's  chap- 
ter on  pathology,  I  find  the  following:  "Subluxations  of  tar- 
sal  and  carpal  bones  must  occur,  I  think,  in  a  considerable 
number  of  instances.  I  mean  by  subluxations,  some  dis- 
turbance of  the  proper  relations  of  a  bone  without  absolute 
displacement,  and  I  believe  that  such  disturbance  may  be 
produced  either  by  the  traction  of  a  band  of  adhesion  about 
the  joints,  or  by  a  twist  or  other  direct  violence."  Grant  the 
possibility  of  subluxation  in  the  arthrodial  joints  of  the  car- 
pus and  tarsus,  it  is  not  improbable  to  conceive  of  them  in 
any  other  joint.  As  a  pure  example  of  "bone  setting,"  one 
of  my  recent  cases  is  apropos.  A  lady  stepped  on  some  small 
hard  object,  the  point  of  contact  being  just  under  the  instep. 
Sharp  pain,  localized  on  top  of  the  instep,  began  at  once,  and 


376  PRINCIPLES  OF  OSTEOPATHY 

was  not  relieved  by  heat  or  other  antiphlogistic  measures. 
Forty-eight  hours  after  the  onset  of  pain,  I  was  called  to 
examine  the  foot.  Found  some  swelling  over  the  instep, 
but  palpation  localized  the  pain  in  the  articulation  between 
the  scaphoid  and  internal  cuneiform.  Any  attempt  at  local 
movement  of  this  joint  caused  sharp  pain.  The  patient  could 
not  stand  on  the  foot,  on  account  of  the  pain,  which  was  in- 
creased thereby.  Kxtension  of  the  foot,  with  firm  pressure 
<>n  the  upper  side  of  the  articulation,  caused  a  very  loud 
sound,  the  prominence  of  the  scaphoid  was  not  so  apparent, 
and  the  patient  could  put  her  weight  on  the  foot  immediate- 
ly. This  was  a  case  of  tarsal  subluxation.  If  the  same  de- 
gree of  displacement  had  existed  in  a  vertebral  articulation, 
the  effect  on  circulation  in  the  nerve  centers  of  the  cord 
might  have  caused  very  widespread  symptoms. 

The  subluxations  treated  by  "bone  setters"  have  usual- 
ly been  those  which  occasioned  pain  in  the  joint.  The  osteo- 
path does  not  depend  upon  pain  as  a  symptom  of  subluxa- 
tion. but  makes  palpation  the  true  guide. 

Enarthrodial  and  Arthrodial  Joints. — When  the  head 
of  the  femur  is  forced  out  of  the  ascetabulum,  there  is  more 
or  less  tearing  of  ligaments,  with  consequent  inflammation. 
Replacement  of  the  head  is  not  accomplished  without  a  dis- 
tinct sound.  The  sound  is  considered  as  audible  evidence  of 
successful  operation.  The  same  is  true  of  the  shoulder  joint. 
The  great  range  of  movement  in  these  joints  necessarily  re- 
quires lax  ligaments,  therefore  great  separation  of  the  joint 
surfaces  is  possible.  The  arthrodial  joints,  in  all  parts  of 
the  body,  are  constructed  on  a  different  principle.  The  range 
of  movement  is  not  great  in  them,  and  their  ligaments  are 
comparatively  short.  The  form  of  the  body  surfaces  of  the 
arthrodial  joints  does  not  limit  motion,  as  in  the  case  of  en- 
arthrodial  joints. 

Replacement  of  the  head  of  the  femur  or  humerus  re- 
quires it  to  move  over  a  ridge  of  bone  or  cartilage,  and  when 
it  sinks  suddenly  into  its  proper  place,  a  sound  is  heard. 
Probably  the  sound  which  accompanies  the  reduction  of  a 


PRINCIPLES  OF  OSTEOPATHY  377 

subluxation  arthrodial  joint,  can  be  explained  by  the  sudden 
readjustment  of  joint  surfaces,  even  though  there  is  no  ridge 
of  bone  or  cartilage  to  glide  over.  It  is  hardly  probable 
that  a  subluxated  joint  has  its  surfaces  smoothly,  though  in 
a  limited  area,  opposed  to  each  other.  Forcing  a  greater 
area  of  contact  corrects  the  unevenly  opposed  surfaces. 

Slow  vs.  Quick  Reduction  of  a  Subluxation. — A  sub- 
luxation  may  be  reduced  slowly,  and  in  such  an  instance  no 
sound  is  heard.  Quick,  sharp  force  is  required  to  overcome 
the  periarticular  tension  which  will  result  in  sudden  replace- 
ment with  sound. 

Bone  Setters'  phrases. — The  use  of  the  statement  by 
some  osteopaths  that  a  "joint  is  out"  or  a  "bone  is  out"  is 
merely  the  direct  appropriation  of  the  "bone  setter's"  pet 
phrase.  The  use  of  the  phrase  "There,  it's  in,"  or  some  sim- 
ilar one,  when  the  sound  of  the  reduction  is  heard,  is  also  an 
appropriation  from  the  same  source.  These  phrases  are  un- 
scientific, and  should  not  be  used  by  any  one  who  pretends  to 
understand  the  true  pathology  of  the  condition  he  is  treat- 
ing. In  the  case  of  sound  due  to  the  breaking  of  adhesions, 
we  could  not  truly  say  a  "bone  is  out,"  nor  in  the  case  of 
subluxation  is  it  right  to  describe  it  thus.  If  it  is  adhesion, 
call  it  so,  and  if  a  subluxation,  describe  it  carefully.  In  this 
way  definite  knowledge  of  joint  conditions  will  be  gathered. 

.Differences  of  Opinion. — There  is  some  difference  of 
opinion  between  osteopaths  as  to  whether  a  subluxation 
must  give  forth  a  sound  when  properly  reduced.  Discus- 
sions of  the  subject  thus  far  have  not  settled  it.  It  seems 
that  the  statement  made  previously  in  this  chapter,  that  slow 
reduction  of  a  subluxation  by  relaxing  movements  will  not 
cause  a  sound,  but  forceful  and  sudden  relaxation  will  do 
so,  about  covers  the  facts.  We  know  that  subluxations  are 
reduced  by  both  methods,  with  satisfactory  results. 

Elsewhere  we  have  called  attention  to  the  treatment  of 
subluxations.  For  comparative  purposes,  and  that  the  stu- 
dent may  know  what  was  understood  concerning  the  manip- 
ulative treatment  of  the  spinal  column  previous  to  the  ad- 


378  PRINCIPLES  OF  OSTEOPATHY 

vent  of  osteopathy,  we  quote  a  portion  of  Dr.  Hood's  chap- 
ter on  "Affections  of  the  Spine." 

"Affections  of  the  Spine,"  Dr.  Hood. — "I  fear  it  must 
be  admitted  that  the  great  importance  of  the  spinal  cord, 
and  the  gravity  of  its  diseases,  have  rather  tended  to  make 
professional  men  overlook  the  osseous  and  ligamentous  case 
by  which  it  is  enclosed,  and  which  is  liable  to  all  the  mala- 
dies that  befall  bones  and  ligaments  elsewhere.  The  quack, 
on  the  other  hand,  who  probably  never  heard  of  the  spinal 
cord,  recognizes  the  presence  of  structures  with  which  he  is 
familiar,  and  deals  with  them  as  he  does  in  other  situations. 
The  result  is  much  the  same  as  in  the  hip  joint.  The  quack 
every  now  and  then  cures  conditions  which  the  authorized 
practitioner  had  regarded  with  a  sort  of  reverence  because 
they  were  "spinal" ;  and  he  every  now  and  then  kills  a  pa- 
tient because  this  reverence  did  not  exist  for  his  protection. 
If  the  profession  generally  would  so  study  the  diseases  of  the 
spinal  cord  as  to  rescue  them  from  specialists,  the  first  step 
would  be  taken  towards  rescuing  the  disease  of  the  vertebral 
column  from  quacks. 

"Crick  in  the  Back." — "However,  the  matter  may  be  ex- 
plained, it  is  quite  certain  that  many  people  now  resort  to 
bone  setters,  complaining  of  a  "crick"  or  pain  or  weakness 
in  the  back,  usually  consequent  upon  some  injury  or  undue 
exertion,  and  that  these  applicants  are  cured  by  movements 
of  flexion  and  extension,  coupled  with  pressure  upon  any 
painful  spot. 

Manipulation  of  the  Neck. — "In  a  few  cases,  Mr.  Hut- 
ton  was  consulted  on  account  of  stiffness  about  the  neck  or 
cervical  vertebrae,  and  he  then  was  accustomed  to  straighten 
them.  *  His  left  forearm  would  be  placed  un- 

der the  lowered  chin  of  the  patient,  with  the  hand  coming 
round  to  the  base  of  the  occipital  bone.  The  right  thumb 
would  then  be  placed  on  any  painful  spot  on  the  cervical 
spine,  and  the  chin  suddenly  elevated  as  much  as  seemed 
to  be  required.  As  far  as  my  observation  extends,  the  in- 
stances of  this  kind  were  not  bona  fide  examples  of  adhe- 


PRINCIPLES  OF  OSTEOPATHY 


379 


PIG.  151.     Illustration  from  "On  Bone  Setting"  by  Whar- 
ton  P.   Hood,  1871. 


sions,  but  generally  such  as  might  be  attributed  to  slight 
muscular  rigidity,  or  even  to  some  form  of  imaginary  mal- 
ady. The  benefit  gained  was  probably  rather  due  to  the 
pain  of  the  operation  and  the  effect  produced  by  it  upon  the 
mind  of  the  patient  than  to  any  actual  change  in  the  physi- 
cal condition  concerned. 

Manipulation  of  the  Back. — "For  the  lower  regions  of 
the  spine  he  had  two  methods  of  treatment  differing  in  de- 
tail but  not  in  principle.  In  the  first,  when  the  painful  spot 
was  found  the  patient  was  made  to  get  out  of  bed  and  to 
stand  facing  its  side,  with  the  front  of  the  legs  or  perhaps 
the  knees — according  to  the  height  of  the  patient  and  the 
bedstead — pressed  against  it.  She  was  then  told  to  bend 
forward  until  the  bed  was  touched  by  the  elbows.  His  left 
arm  was  then  placed  across  the  chest,  and  the  thumb  of 
the  right  hand  upon  the  painful  spot.  Firm  pressure  was 
then  made  with  the  thumb,  and  as  soon  as  he  felt  that  he 
had  settled  himself  into  such  a  position  that  he  could  obtain 


380  PRINCIPLES  OF  OSTEOPATHY 

the  full  power  of  the  left  arm,  the  patient  was  told  to  assume 
the  erect  posture  with  as  much  rapidity  and  vigor  as  she 
could  command.  This  movement  was  facilitated  and  ex- 
pedited by  the  throwing  up  of  his  left  arm  and  the  opposing 
force  of  the  right  thumb.  As  a  rule  there  seemed  to  be  two 
painful  spots,  answering  to  the  upper  and  lower  border  of 
the  affected  vertebrae,  so  that  the  manoeuvre  would  require 
to  be  repeated. 

"In  the  second  method  the  patient  was  seated  in  a  chair 
placed  a  short  distance  from  the  wall,  so  that  the  feet  could 
be  firmly  pressed  against  it.  She  was  told  to  bend  forward 
and  place  her  arms  between  her  legs,  with  the  elbows  rest- 
ing against  the  inner  side  of  the  knee ;  to  sit  firmly  on  the 
chair,  and  at  a  given  signal  to  throw  herself  upright.  The 
operator  passed  his  left  arm  under  the  chest,  placed  his  right 
thumb  on  the  painful  spot,  and,  in  order  to  obtain  firm  and 
resisting  pressure,  rested  his  elbow  against  the  back  of  the 
chair.  The  signal  being  given,  the  operator,  keeping  his  fist 
clenched  so  as  to  support  his  thumbs  and  the  elbow  being 
held  firm  in  its  position,  when  the  patient  throws  herself 
upright,  resists  the  approach  of  her  back  to  the  chair  and 
bends  her  head  and  shoulders  as  far  backwards  as  possible, 
the  position  of  the  feet  preventing  any  forward  movement. 

Treatment  of  Upper  Dorsal. — "These  two  methods  are 
used  for  cases  in  which  pain  is  present  in  the  dorsal  verte- 
brae below  the  eighth,  or  in  any  of  the  lumbar.  The  treat- 
ment used  for  the  upper  dorsal  and  lower  cervical  vertebrae 
was  to  place  the  operator's  knee  against  the  painful  spot 
and,  with  the  hands  placed  upon  the  shoulders,  to  draw  the 
upper  part  of  the  body  as  far  back  as  possible. 

"In  cases  when  pain  was  complained  of  in  the  dorsal 
and  lumbar  region  and  the  backward  movements  did  not 
afford  the  required  relief,  the  patient  was  made  to  bend  side- 
ways, and  a  similar  process  was  gone  through  as  in  the 
other  manipulations. 

Comment. — "As  a  commentary  on  all  this,  there  is 
manifestly  little  to  say,  except  that  the  size  of  the  vertebral 


PRINCIPLES  OF  OSTEOPATHY  381 

column  is  such  as  to  admit  of  considerable  diminution  with- 
out injury  to  the  cord,  and  that  the  bones  and  ligaments  of 
the  column  as  already  observed  are  liable  to  the  same  results 
of  injury  and  to  the  same  diseases  that  befall  bones  and 
ligaments  elsewhere. 

Differential  Diagnosis. — "The  surgeon  who  is  consulted 
about  a  case  of  spinal  malady  should  first  of  all  make  sure 
that  he  is  not  frightened  by  a  bugbear,  and  should  then  pro- 
ceed to  determine  by  scientific  methods  of  examination 
whether  or  not  he  is  in  the  presence  of  disease  of  the  nervous 
centers,  or  of  caries,  abscess  or  other  destructive  change  in 
the  vertebral  column.  On  such  points  as  these  no  man  who 
possesses  a  thermometer,  a  microscope  and  a  test  tube  has 
any  excuse  for  remaining  long  in  doubt ;  and  if  he  is  able  to 
exclude  the  possibility  of  such  conditions,  he  may  then  re- 
gard the  spine  simply  as  a  portion  of  the  skeleton  and  may 
deal  with  it  accordingly.  Here,  as  elsewhere,  injury  and  rest, 
or  rest  and  counter  irritation,  may  produce  adhesions  that 
painfully  limit  movement  and  that  may  at  once  be  broken  by 
resolute  flexion  and  extension.  Here,  as  elsewhere,  partial 
displacement  may  occur  and  may  be  rectified  by  pressure 
and  motion.  In  the  lower  cervical,  the  dorsal  and  the  lum- 
bar portions  of  the  spine  the  change  of  position  of  any  single 
vertebra  can  only  be  slight — enough  to  produce  pain  and 
stiffness,  but  not  enough  to  produce  visible  deformity.  In 
the  highest  region,  however,  partial  dislocations  are  some- 
times more  manifest.  The  following  case  is  quoted  from  the 
hospital  report  of  the  Medical  Times  and  Gazette  of  August 

5th,  1865 :  'John  S ,  aged  21,  laborer,  of  St.  Mary's  Cray, 

was  admitted  on  May  26th,  1865,  under  Mr.  Hilton.  States 
that  he  has  been  ailing  for  the  last  three  months ;  loss  of  ap- 
petite and  general  debility;  has,  however,  followed  employ- 
ment. On  Sunday,  May  14,  he  was  stooping  down  to  black 
his  boots  as  they  were  on  his  feet,  when  suddenly  he  "felt  a 
snap"  in  the  upper  and  back  part  of  his  neck;  he  felt  as  if 
someone  had  struck  him  there.  About  a  quarter  of  an  hour 
after  he  became  insensible  and  continued  so  about  half  an 


382  PRINCIPLES  OF  OSTEOPATHY 

hour;  then  he  felt  a  stiffness  and  numbness  at  the  sides  and 
back  of  his  head  and  the  back  of  his  neck,  with  a  fullness  in 
the  throat  and  difficulty  of  swallowing.  At  first  he  had  no 
loss  of  power  over  his  limbs,  only  slight  pain  down  his  right 
arm ;  some  days  after  admission,  however,  he  had  partial 
loss  of  power  in  the  right  arm,  which  shortly  recovered 
itself.  On  admission  he  carries  his  head  fixed,  and  has  pain 
on  slightest  attempt  to  rotate,  flex  or  extend  the  head;  his 
jaw  is  partially  fixed,  and  he  cannot  open  his  mouth  wide 
enough  to  admit  of  a  finger  being  passed  to  the  back  of  the 
pharynx;  his  voice  is  thick  and  guttural;  deglutition  not  at- 
tended by  any  great  uneasiness.  Complains  of  all  symptoms 
before  enumerated.  Externally,  over  the  spine  of  the  second 
cervical  vertebra,  there  is  a  tumor  hard  and  resisting,  but 
tender  on  pressure;  this  is  evidently  formed  by  the  undue 
prominence  of  the  spine  of  the  axis  itself;  the  tenderness 
is  not  general,  but  circumscribed;  the  parts  all  around  are 
numb.  He  was  put  on  his  back  on  a  hard  bed,  his  head 
was  slightly  elevated  and  a  small  sand  bag  was  placed 
'beneath  the  projecting  spine,  and  the  whole  head  main- 
tained in  a  fixed  position  by  larger  sand  bags.  He  was 
ordered  pulv.  Dov.  gr.  V;  hydr.  c.  creta;  gr.  iij.,  bis  die. 
This  was  continued  for  about  ten  days,  when  his  gums 
became  affected  slightly,  and  it  was  then  omitted.  Marked 
improvement  has  taken  place  in  his  general  appearance 
and  more  particularly  in  his  special  symptoms.  He  con- 
tinued until  July  3,  gradually  and  steadily  improving.  He 
then  had  acute  rheumatic  inflammation  of  the  right  knee 
and  elbow  joint,  followed  in  a  day  or  two  by  a  similar 
state  in  the  left  knee  joint.  There  was  no  evidence  of  a 
pyaemic  state.  The  joints  were  blistered;  he  has  been 
treated  with  pot.  nitr.  and  lemon  juice  and  is  now  fast  re- 
covering. The  tenderness  and  all  the  symptoms  have  disap- 
peared, the  projection  still  remaining,  and  he  expresses  him- 
self much  relieved  by  the  continued  rest  in  bed.' 

Size  of  the  Vertebral  Canal. — "Mr.  Hilton,  in  remark- 
ing on  this  case,  observed  that  it  had  been  demonstrated  that 


PRINCIPLES  OF  OSTEOPATHY  383 

the  area  of  the  vertebral  canal  might  be  diminished  by  one- 
third,  provided  that  the  diminution  was  slowly  effected, 
without  giving  rise  to  any  alarming  or  indeed  marked  symp- 
toms of  compression  of  the  cord. 

Conservative  vs.  Radical  Treatment. — "Now,  there  can 
be  no  doubt  that  most  surgeons  would  agree  that  Mr.  Hilton 
exercised  a  sound  discretion  in  simply  placing  this  man  in 
conditions  favorable  to  recovery,  or  in  keeping  him  at  rest 
until  the  axis  was  fixed  in  its  new  position  and  the  spinal 
cord  accustomed  to  the  change  in  its  relations.  There  can 
be  little  doubt  that  Mr.  Hutton  would  have  made  thumb 
pressure  on  the  prominent  spine  while  he  sharply  raised 
the  head.  The  probability  is  that  he  would  by  this  manoeu- 
vre have  cured  his  patient;  the  possibility  is  that  he  might 
have  killed  him.  This  sort  of  'make  a  spoon  or  spoil  a  horn' 
practice  we  may  contentedly  leave  to  quacks,  and  without 
risking  reputation  in  doubtful  cases.  I  think  we  may  find 
a  considerable  number  which  are  not  doubtful,  in  which 
skilled  observation  may  exclude  all  elements  of  danger, 
and  in  which  the  rectification  of  displacement  or  the  rup- 
ture of  adhesions  will  be  certainly  followed  by  the  most 
favorable  results.  For  the  discovery  of  these  cases  no  set- 
tled rules  can  be  laid  down,  since  they  can  only  be  known 
by  negations — by  the  absence  of  the  symptoms  that  would 
give  warning  of  danger.  The  diagnosis  must  be  made  in 
each  instance  for  itself,  and  in  each  must  depend  upon  the 
sagacity  and  skill  of  the  practitioner." 


384  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  XIX. 

POSITIONS   FOR   KXAMIXATIOX. 

Observation. — The  method  of  examination  should  be 
somewhat  affected  by  one's  getting  a  sense  of  the  individu- 
ality of  the  patient.  There  are  many  things  which  one 
should  be  trained  to  observe  quickly,  such  as  the  pose  and 
movement  of  the  patient,  nutrition,  character  of  the  skin, 
etc.  All  of  these  things  give  a  sense  of  direction  to  the 
examination,  i.  e.,  odd  poses,  compensatory  movements,  or 
cachexias  lead  one  to  try  to  determine  the  causes  of  these 
very  apparent  abnormalities.  Minor  phases  of  these  things 
may  escape  our  cursory  glance,  but  it  is  unwise  to  com- 
mence any  examination  without  first  determining  the 
probable  region  or  regions  especially  requiring  examina- 
tion. This  does  not  mean  being  particularly  guided  by 
the  patient's  own  statement,  but  rather  seeking  to  exer- 
cise one's  powers  of  observation  and  deduction. 

"We  wish  it  distinctly  understood  that  we  are  striv- 
ing here  to  explain  a  special  form  of  examination  which 
is  only  a  part  of  general  diagnostic  work.  An  examina- 
tion which  comprehends  merely  the  use  of  palpation  would 
give  a  limited  understanding  of  a  patient's  ailment,  but 
since  this  book  is  concerned  with  elucidating  groups  of 
phenomena  which  can  quite  clearly  be  recognized  by  pal- 
pation, we  will  not  use  time  or  space  to  describe  other 
coordinate  methods  which  are  ably  taught  in  other  texts. 

In  order  to  be  systematic  in  the  examination  of 
patients,  it  is  well  to  adopt  the  use  of  a  certain  routine  of 
positions  which  will  best  show  the  details  of  osseous  struc- 
ture. 


PRINCIPLES  OF  OSTEOPATHY 


385 


Testing  Alignment  and  Flexibility. — The  first  position, 
as  illustrated  in  Fig.  152,  flexes  the  spinal  column  and 
makes  the  spinous  processes  prominent.  This  position  is 
valuable  in  examining  even  very  fleshy  people.  Approxi- 
mation or  separation  of  the  spines  can  be  noted,  also 


PIG.    152.     Flexion  of  the  spine  in   the  vertical  position  to  make   the 
spinous  processes  prominent. 


386  PRINCIPLES  OF  OSTEOPATHY 

lateral  deviation.  If  the  amount  of  flesh  over  the  spines, 
as  in  fat  people,  precludes  the  use  of  the  sense  of  sight, 
you  can  ascertain  the  relation  by  the  sense  of  touch. 

Sense  of  Touch. — We  wish  to  emphasize  the  necessity 
of  the  student's  acquiring  the  habit  of  depending  on  the 
sense  of  touch,  rather  than  of  sight.  In  all  osteopathic 
examinations,  the  sense  of  touch  should  be  used  to  obtain 
those  data  concerning  structure  which  form  the  basis  of  all 
diagnosis.  Remember  that  you  can  not  see  bone,  muscles 
and  glands,  but  you  can  feel  them. 

Inspection. — AYhile  the  patient  is  sitting  erect,  ascer- 
tain the  flexibility  of  the  spinal  column.  Note  the  position 
of  the  scapulae,  whether  near  or  far  from  the  spinal  col- 
umn, whether  unevenly  placed.  Note  the  development 
of  the  trapezius,  latissimus  dorsi,  and  erector  spinae,  i.  e., 
observe  their  surface  markings.  If  the  patient  does  not 
voluntarily  relax  while  in  the  erect  position,  ask  him  to 
assume  his  normal  posture.  This  will  illustrate  the  points 
of  greatest  spinal  stress  and  show  how  the  spinal  column 
acts  in  its  normal  weight  carrying  capacity. 

Palpation  of  the  Ribs. — Fig.  153  illustrates  a  method 
of  bringing  the  ribs  prominently  into  view,  or  in  case  of 
fleshy  persons,  making  it  easy  to  palpate  them.  By  pull- 
ing the  arm  up  and  across  the  chest,  the  latissimus  dorsi 
is  stretched  which  brings  the  four  lower  ribs  into  a  good 
position  for  examination.  The  movement  of  the  scapula 
away  from  the  vertebrae  makes  it  easier  for  the  examiner 
to  feel  the  angles  of  the  fourth  and  fifth  ribs.  It  is  not  well 
to  depend  on  this  position  for  evidence  of  rib  subluxations, 
because  the  tension  of  the  latissimus  dorsi  brings  at  least 
the  four  lower  ribs  into  proper  alignment.  The  spacing 
of  these  ribs  will  then  be  equal. 

The  chief  value  of  this  position  is  to  give  the  exam- 
iner better  opportunity  to  palpate  the  angles  of  the  ribs 
above  the  ninth  and  to  note  the  changed  relations  which 


PRINCIPLES  OF  OSTEOPATHY 


387 


FIG.    153.     Position  to  accentuate  the  prominence  of  the  ribs. 

may   take   place   at   the   anterior   end   of   the   ninth,   tenth, 
eleventh  and  twelfth  ribs. 

Palpation  of  the  Spine. — After  gathering  as  much  in- 
formation as  possible  by  observing  the  form  of  the  back, 
position  of  the  scapulae  and  contour  of  the  muscles,  ex- 
amine the  spine  by  means  of  your  sense  of  touch.  To  do 
this,  have  the  patient  sit  erect,  being  careful  not  to  exag- 
gerate the  normal  posture,  i.  e.,  bend  the  spine  far  for- 
ward or  backward  in  the  lumbar  region.  A  marked  ten- 


388 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    154.     Palpation  of   the   spine   in   the   vertical  position. 

clency  to  either  position  is  indicative  of  weak  muscles. 
Use  the  index  and  middle  finger  of  either  hand  to  care- 
fully note  the  relations  of  the  individual  vertebrae,  as  in 
Fig.  154.  Begin  at  the  first  dorsal  and  work  downward 
to  the  sacrum.  Lateral  subluxations  are  easily  noted  with 
the  patient  in  this  position.  Gentle  digital  pressure  may 
be  made  at  the  prominent  side  of  any  subluxated  vertebra 
to  determine  the  degree  of  sensitiveness.  This  informa- 


PRINCIPLES  OF  OSTEOPATHY 


389 


tion  is  best  secured  when  the  patient  is  reclining,  because 
the  muscles  are  relaxed.  While  the  patient  is  sitting  there 
is  usually  too  much  contraction  of  both  intrinsic  and  ex- 
trinsic muscles  of  the  back  to  allow  much  examination, 
outside  of  mere  study  of  alignment  and  normal  or  ab- 
normal curves. 


FIG.   155.     Palpation  of  the  dorsal  muscles,  horizontal  position. 

Now  have  the  patient  recline  on  the  right  or  left  side, 
which  is  most  convenient,  as  in  Fig.  155.  Examine  the  con- 
dition of  the  spinal  muscles  by  using  the  ball  of  the  fingers 
of  one  or  both  hands.  Be  careful  not  to  use  the  ends  of 
the  fingers.  Commence  your  examination  at  the  first 
dorsal  by  noting  the  amount  of  sensitiveness  directly  on 
or  between  the  spinous  processes  all  the  way  to  the  coccyx. 
To  elicit  this  sensitiveness  use  a  moderate  pressure,  equal 
to  about  six  pounds.  With  this  much  pressure  the  patient 


390 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  156.     Diagram  of  dorsal  muscles,  first,  second,  third  and  fifth 
layers. 


PRINCIPLES  OF  OSTEOPATHY 


391 


FIG.     157.     Diagram    of    dorsal    muscles — fourth    layer.       Adapted 
from  a  diagram  in  Cunningham's  Anatomy. 


392  PRINCIPLES  OF  OSTEOPATHY 

will    be    able    to    distinguish    easily    between    the    sense    of 
mere  pressure  and  a  painful  or  hyper-sensitive  feeling. 

Begin  once  more  at  the  first  dorsal  and  examine  along 
the  sides  of  the  spines  and  about  three  inches  from  them. 
This  space  brings  the  internal  and  middle  groups  of  in- 
trinsic muscles  under  your  fingers. 

Extrinsic  and  Intrinsic  Muscles  of  the  Back. — In 
speaking  of  extrinsic  and  intrinsic  muscles  of  the  back, 
we  desire  you  to  bear  in  mind  the  different  groups  as  they 
are  noted  in  dray's  Anatomy.  Gray  divides  them  into 
five  layers.  The  first  three  layers  are  extrinsic,  i.  e.,  arise 
from  vertebrae  and  insert  into  the  humerus,  scapulae,  or 
ribs.  They  depend  upon  the  intrinsic  muscles  of  the 
fourth  and  fifth  layers  to  fix  the  spine  so  that  operating 
from  the  spinal  column  as  a  fixed  point,  they  can  move 
the  upper  extremities  and  ribs. 

AYhile  palpating  a  back  which  is  moderately  well  mus- 
cled, you  will  be  able  to  feel  through  the  upper  three 
layers  and  distinguish  the  condition  of  the  muscles  of  the 
fourth  layer.  It  is  important  that  the  student  should  learn 
to  feel  through  the  soft  tissues  to  harder  ones  below.  Skill 
in  detecting  varying  degrees  of  density  and  hardness  is  an 
absolutely  essential  qualification  of  the  diagnostician. 

A  careful  dissection  of  the  fourth  layer  wrill  disclose 
the  fact  that  there  are  three  parallel  groups  of  muscles. 
The  first  is  the  spinalis  dorsi  which  lies  on  the  side  of  the 
spines.  The  second  group  lies  more  on  the  transverse 
processes.  The  longissimus  dorsi  and  its  continuations 
make  up  this  group.  The  sacro-lumbalis  and  continuations 
make  up  the  third  group  which  lies  on  the  angles  of  the 
ribs.  Careful  palpation  will  distinguish  these  divisions. 

The  Diagnostic  Value  of  Hyperaesthesia. — Different 
points,  along  the  line  of  the  first  group,  which  are  hyper- 
sensitive, may  be  evidence  of  direct  strain  of  a  single  ver- 
tebral articulation,  or  the  result  of  a  visceral  reflex,  or  even 
in  sympathy  with  a  rib  subluxation  which  affects  sensory 


PRINCIPLES  OF  OSTEOPATHY  393 

nerves  reaching  the  same  segment  of  the  cord  from  which 
its  nerves  arise.  Hyperaesthesia  directly  upon  the  spines 
is  usually  found  in  connection  with  depression  or  eleva- 
tion of  the  spines,  not  lateral  subluxation. 

Hyperaesthesia  at  points  in  the  second  group  of  mus- 
cles, i.  e.,  the  longissimus  dorsi  and  continuations  over 
the  transverse  processes,  may  result  from  vertebral  or 
costal  subluxation,  or  muscular  contraction  caused  by 
visceral  reflex. 

When  this  excessive  sensitiveness  is  found  at  the 
angles  of  the  ribs,  in  the  short  muscular  divisions  of  the 
sacro-lumbalis  and  continuations,  it  nearly  always  signi- 
fies an  irritation  from  a  costal  subluxation. 

The  examination  of  the  ribs  should  be  made  while  the 
patient  is  in  this  reclining  position.  The  fingers  should 
follow  the  angles  of  the  ribs,  noting  the  spacing,  special 
prominence  or  depression  of  an  angle,  then  noting  the 
compensatory  changes  at  the  chondro-costal  articulations. 
In  this  way  the  relation  of  the  ribs  to  each  other  can  be 
determined. 

When  pain  exists  at  any  one  of  the  points  named,  or  the 
digital  pressure  arouses  a  painful  reflex,  all  of  the  sensory 
points  along  the  course  of  the  spinal  nerve  should  be  tested 
in  order  to  determine  the  extent  of  the  nerve  irritation. 
Take  for  example,  the  point  on  the  spinal  column  between 
the  fifth  and  sixth  dorsal.  After  examining  these  two  spines 
and  finding  them  well  placed,  our  digital  pressure  at  the 
sides  might  cause  a  painful  reflex,  i.  e.,  the  patient  might 
complain  of  our  pressure.  Then  we  test  the  point  over  the 
transverse  processes  and  angles  of  the  ribs,  and  even  the 
junction  of  the  ribs  and  costal  cartilages.  If  hyperaesthesia 
is  present  at  all  points  in  the  distribution  of  the  fifth  spinal 
-nerve,  we  understand  that  the  original  irritation  may  be 
slight,  but  long  continued,  or  strong  and  of  short  duration. 
If  no  osseous  displacement  is  discoverable,  which  has  a  rela- 
tionship with  a  hypersensitive  nerve,  we  must  look  for  evi- 
dence of  disturbed  functioning  by  the  viscus  most  nearly 


394  PRINCIPLES  OF  OSTEOPATHY 

related.  The  original  irritation  might  have  been  an  exces- 
sive demand  on  the  ability  of  the  viscus,  as  in  the  case  of 
the  stomach  being  overloaded. 

In  any  case,  the  discovery  of  what  appears  to  be  an 
osseous  lesion,  leads  us  to  test  the  condition  of  its  related 
nerves.  If  the}'  do  not  show  undue  excitability,  the  lesion 
is  doubtful  as  a  causative  factor.  A  careful  examination  of 
vertebral  spinous  processes  may  show  many  deviations  from 
symmetrical  development,  and  the  diagnostician  should 
guard  against  the  false  evidence  of  these  distorted  spines. 
If  a  spine  has  been  distorted  by  unequal  development,  there 
should  be  no  sensitiveness  around  it  except  as.  the  result 
of  a  visceral  reflex.  In  case  of  such  visceral  reflex,  the  ex- 
aminer can  not  help  being  misled  as  to  the  value  of  the  ap- 
parent osseous  malformation.  His  ringers  can  not  inform 
him  that  what  he  considers  an  osseous  lesion  is  in  reality 
bad  development.  The  only  way  he  can  escape  from  mak- 
ing a  mistake  is  by  continuing  his  examination  without  hold- 
ing a  positive  idea  that  he  has  found  the  cause.  The  history 
and  development  of  the  case  may  arouse  strong  doubts  as 
to  the  value  of  his  discovered  spinal  lesion. 

Your  attention  is  called  to  this  possible  mistake  in  val- 
uation of  a  lesion,  so  that  you  may  not  become  wedded  to 
the  idea  that,  when  you  have  found  what  appears  to  be  a 
misplacement,  you  are  free  to  end  your  examination  and 
pronounce  a  competent  judgment. 

Test  Muscular  Tension. — -While  the  patient  is  on  his 
side,  examine  carefully  the  amount  of  tension  in  these  three 
groups  constituting  the  fourth  layer.  After  considerable 
education  of  the  sense  of  touch,  it  will  be  possible  for  you 
to  determine  that  the  points  under  your  fingers  are  probably 
too  sensitive.  When  these  muscles  feel  hard  and  unyield- 
ing, they  are  usually  sore  to  pressure.  The  contractured 
condition  of  the  muscle  has  affected  the  sensory  nerve  fila- 
ments in  two  ways :  First,  by  direct  pressure  between  the 
contracted  muscle  bundles ;  second,  by  retention  of  meta- 
bolic waste  products  which  result  in  chemical  poisoning. 


PRINCIPLES  OF  OSTEOPATHY 


395 


FIG.    158.     Testing    the    pliability    of    the    interscapular    portion    of 
the  spinal  column. 


Thoracic  Flexibility. — Fig.  158  illustrates  a  method  of 
ascertaining-  the  elasticity  of  the  dorsal  spine  and  thorax. 
This  procedure  assists  in  estimating  the  general  condition 
of  the  body.  If  the  thorax  is  fixed,  inelastic,  respiration 
can  not  be  carried  on  properly.  Oxygenation  of  the  blood 
will  be  imperfect.  If  desired  we  may  palpate  the  spinous 
processes  and  the  musculature  while  the  patient  is  in  this 
prone  position. 

Examination  of  the  Abdomen.  —  Fig.  159  shows  the 
proper  position  of  the  patient  for  examination  of  the  abdo- 
men. The  knees  being  drawn  up  allows  relaxation  of  ab- 
dominal muscles.  Where  the  abdomen  is  very  sensitive  to 
the  touch,  either  because  of  pain  or  ticklishness,  use  the 
whole  hand  until  the  patient  becomes  somewhat  accustomed 
to  the  touch.  Sometimes  it  is  necessary  for  the  physician 


396 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    159.     Palpation  of  the  abdomen. 

to  lift  the  feet  from  the  table  and  flex  the  knees  quite  close 
to  the  abdomen.  A  steady,  even  pressure  of  the  hand  on 
the  abdomen  will  soon  become  non-irritating  to  the  patient, 
and  deeper  palpation  can  be  made. 

If  the  examination  is  a  general  one,  commence  your 
work,  with  the  patient  in  this  position,  by  palpating  the 
thorax.  Xote  form  and  flexibility,  especially  the  flexibility 
of  the  five  lower  ribs.  The  free  movement  of  these  ribs  is 
essential  to  many  functions,  chiefly  respiration,  but  it  also 
affords  a  sort  of  rhythmical  massage  to  the  liver  and 
stomach. 

Such  observations  of  form  and  flexibility  are  very  gen- 
eral, but  they  lead  invariably  to  some  clue  of  especial  value 
in  the  search  for  effects  and  their  causes. 

Elevation  or  Depression  of  Ribs. — Note  the  spacing  of 
the  ribs  to  determine  whether  any  rib  is  elevated  or  de- 


PRINCIPLES  OF  OSTEOPATHY 


397 


pressed.  Palpate  the  chondro-costal  articulations  for  mis- 
placements, especially  note  the  articulations  of  the  tenth  ribs, 
they  are  frequently  broken  loose  and  form  additional  float- 
ing- ribs.  They  are  usually  depressed  slightly  under  the 
ninth. 

After  palpation  of  the  chest,  use  percussion,  then  auscul- 
tation, according  to  the  methods  outlined  in  the  best  text- 


FIG.   160.     Position  for  examination  of  the  prostate  gland. 


398 


PRINCIPLES  OF  OSTEOPATHY 


books  on  diagnosis.  By  the  use  of  all  these  physical  meth- 
ods it  is  possible  to  arrive  at  a  very  definite  conclusion  of 
the  state  of  the  thoracic  viscera. 

The  abdomen  should  be  palpated,  then  percussed. 
These  two  methods  should  make  evident  any  organic  change 
in  the  abdominal  viscera. 

Examination  of  the  Rectum  and  Prostate  Gland. — Fig. 
160  illustrates  a  position  for  examining  the  rectum  and  pos- 
tate  gland.  Fig.  161  is  the  well-known  Simm's  position 
which  may  be  used  for  the  same  purpose  as  the  preceding. 

Other  positions  used  by  the  osteopath  for  examination 
and  treatment  are  the  well-known  gynecological  positions, 
genu-pectoral  and  Trendelenburg. 

Examination  of  the  Neck. — For  easy  examination  of 
the  neck,  the  patient  should  be  recumbent,  as  in  Fig.  159. 
The  muscles  of  the  neck  must  have  all  tension  removed 
so  that  the  examiner's  fingers  can  feel  the  processes  of  the 
cervical  vertebrae. 

A  flat  table  instead  of  the  model  shown  in  the  illus- 
tration is  better.  A  hard  small  pillow  may  be  used  to  sup- 
port the  head. 


FIG.   161.     Simms'   position. 


PRINCIPLES  OF  OSTEOPATHY  399 

Since  the  spinous  processes  in  the  cervical  region  are 
short  and  bifid,  and  oftentimes  developed  unevenly  and 
are  covered  with  several  layers  of  muscles  and  ligaments, 
it  is  not  satisfactory  to  use  them  as  landmarks  for  relations 
of  cervical  vertebrae. 

The  tubercles  on  the  transverse  .processes  are  easily 
palpated,  hence  these  serve  as  guides  in  the  detection  of 
slight  misplacements  of  cervical  vertebrae. 

The  transverse  processes  of  the  atlas  are  usually  large 
and  sufficiently  prominent  to  enable  the  examiner  to  ascer- 
tain accurately  its  position.  When  the  atlas  is  in  its  true 
position,  its  transverse  processes  will  be  found  about  mid- 
way between  the  mastoid  processes  of  the  temporal  bones 
and  the  angles  of  the  jaw.  This  relationship  may  appear 
untrue  when  the  mastoid  processes  are  quite  large  or  small, 
or  the  angles  of  the  jaw  are  more  or  less  obtuse.  It  is 
necessary  to  study  the  relative  development  and  positions 
in  every  case,  on  both  sides,  in  order  to  discover  whether 
a  subluxation  exists.  The  fact  that  nearly  all  subluxations 
of  the  atlas  are  twists  instead  of  direct  forward  or  backward 
displacements,  makes  it  comparatively  easy  to  detect  the 
inequalities  and  understand  the. faulty  position.  Sensitive- 
ness will  be  found  in  the  tissues  on  the  side  whose  trans- 
verse process  is  posterior.  In  case  there  is  marked  sensi- 
tiveness on  both  sides,  that  is,  on  the  posterior  surfaces  of 
both  transverse  processes,  the  atlas  is  probably  drawn 
slightly  posterior  on  both  sides  by  the  severe  contraction 
of  its  attached  muscles. 

The  third  cervical  vertebra  seems  to  be  easily  sublux- 
atecl.  It  is  usually  twisted,  not  sufficiently  to  lock  its  ar- 
ticular processes,  but  just  enough  to  make  the  dorsal  sur- 
face of  its  inferior  articular  process  easily  palpable  through 
the  muscles  which  lie  over  it.  This  prominent  point  will 
be  sensitive  because  the  muscles  over  it  are  always  tense. 

Sometimes  the  sixth  cervical  vertebra  is  twisted.  When 
this  condition  exists,  there  is  marked  disturbance  of  circu- 
lation in  the  head.  The  patient  is  usually  wakeful  and 


400  PRINCIPLES  OF  OSTEOPATHY 

excitable  on  account  of  the  congested  condition  of  the  cere- 
bral blood  vessels,  caused  by  the  pressure  on  the  vertebral 
veins. 

Xote  the  tone  of  all  the  cervical  muscles,  the  flexibility 
of  the  neck,  the  temperature  of  the  skin  on  different  parts 
of  the  neck.  Palpate  the  chains  of  lymphatic  glands,  the 
thyroid  and  the  submaxillary  salivary  glands. 

After  a  thorough  palpation  of  the  neck,  look  carefully 
for  any  evidences  of  disturbed  circulation  in  the  head  as 
may  be  evidenced  by  the  appearance  of  the  skin,  mucous 
membrane  of  the  mouth,  the  tonsils,  conjunctiva  or  the 
wearing  of  glasses.  Your  knowledge  of  optics  should  en- 
able you  to  judge  the  general  condition  of  the  eyes  by  in- 
spection of  the  glasses  worn. 

Such  an  examination  of  the  head  and  neck  as  herein 
outlined  should  give  the  examiner  a  good  understanding 
of  the  structural  and  functional  condition  existing  at  the 
time  of  examination,  and  even  guide  him  to  what  other 
parts  of  the  body  may  need  special  attention. 

The  History  of  Lesions. — All  facts  as  to  structure  and 
function,  determined  by  your  examination  are  historical, 
that  is,  they  have  dates  and  circumstances  which  give  them 
much  or  little  value.  The  experienced  diagnostician  de- 
lights in  filling  in  the  life  history  of  the  patient  to  fit  the 
structural  and  functional  changes.  Herein  lies  the  oppor- 
tunity for  the  physician  to  bring  to  his  aid  all  his  resource 
of  experience  and  education  in  judging  how  these  lesions 
have  been  brought  about  and  how  they  are  now  influencing 
other  tissues. 

The  Extremities. — \Yhile  the  patient  is  in  the  recum- 
bent dorsal  position.  Fig.  159,  the  lower  extremities  can  be 
examined.  Xote  the  comparative  length  of  the  legs,  but 
be  careful  to  eliminate  all  possibility  of  mistake  by  observ- 
ing whether  the  patient  is  lying  evenly  on  the  back,  ilia 
same  height,  and  muscles  of  both  legs  equally  relaxed.  A 
measurement  from  the  anterior  superior  iliac  spine  to  the 
internal  malleolus  determines  the  length  of  the  leg. 


PRINCIPLES  OF  OSTEOPATHY  401 

Palpate  the  great  trochanter.  Note  its  relation  to  Ne- 
laton's  line.  These  general  directions  for  examination  will 
determine  the  weak,  disordered  or  diseased  part  of  the  body 
which  requires  your  further  careful  examination. 

Subjective  Symptoms. — You  will  observe  that  thus  far 
nothing  whatever  has  been  said  about  asking  the  patient 
concerning  his  or  her  subjective  symptoms.  It  is  a  general 
principle  underlying  osteopathic  diagnosis  that  objective 
symptoms  are  the  only  true  facts  upon  which  the  diagnos- 
tician dares  base  his  judgment  and  final  verdict.  The  near- 
est approach  to  a  subjective  symptom  thus  far  mentioned 
is  hyperaesthesia.  This  may  frequently  be  judged  by  the 
feeling  of  the  muscle  when  pressed  upon  by  the  fingers. 
The  muscular  reaction  to  the  painful  sensory  impressions 
occasioned  by  the  pressure  can  be  felt.  Usually  we  depend 
upon  the  patient  to  indicate  or  corroborate  our  sense  of 
touch. 

In  actual  practice  this  process  is  not  carried  out  in  its 
entirety.  Time  is  a  factor  in  the  physician's  life  as  well  as 
in  the  life  of  the  business  man.  He  cannot  afford  to  go 
about  his  work  in  this  detective-like  manner.  It  requires 
too  much  time.  We  hear  a  great  deal  of  objection  to  the 
physician's  question  to  his  patient:  "What  is  your  trouble?" 
But  the  answer  to  it  enables  him  to  get  quickly  to  work 
on  the  seat  of  disease  or  at  least  leads  him  quickly  to  it. 
The  physician  who  is  a  good  questioner  saves  much  time. 
He  does  not  accept  the  subjective  symptoms,  merely  goes 
to  work  to  prove  or  disprove  their  verity  by  the  standards 
of  physical  diagnosis. 


402  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  XX. 

MANIPULATION. 

There  has  been  a  very  rapid  evolutionary  develop- 
ment of  manipulation  as  a  therapeutic  method.  It  has 
been  found  to  be  a  wonderfully  adaptable  means  of  al- 
leviating human  suffering.  Undoubtedly  the  principles 
underl ving  any  method  of  manipulation  contribute  some- 
thing to  all  other  so-called  systems  of  movement  cures. 
Manipulation  is  hand  practice  in  the  surgical  sense.  It 
is  applicable  in  a  tremendously  wide  range  of  disorders, 
for  example  the  treatment  of  fractures,  sprains,  breaking 
adhesions,  reducing  dislocations,  assisting  venous  circula- 
tion, stimulating  peristalsis,  reducing  congestions,  quiet- 
ing reflexes,  stimulating  nerve  centers,  and  many  other 
things  of  a  helpful  character. 

The  form  of  manipulation  most  generally  understood 
is  massage.  This  term  is  used  by  some  to  mean  any 
method  of  manual  manipulation.  Massage  is  a  method  of 
manipulation  which  has  been  extensively  practiced  and 
written  about,  hence  there  is  no  excuse  for  the  prevailing 
slovenly  use  of  the  term  to  cover  all  forms  of  hand 
manipulation.  The  characteristic'  movements  of  massage 
are  friction  and  kneading.  They  have  proven  wonderfully 
satisfactory  as  adjuvants  in  overcoming  venous  stasis  and 
toning  the  neuro-muscular  mechanism  of  the  body.  No 
one  who  is  at  all  conversant  with  the  phenomena  of  nat- 
ural recovery  fails  to  recognize  the  great  assistance  wrhich 
even  the  crudest  use  of  massage  furnishes. 

The  next  step  of  a  scientific  character  in  the  devel- 
opment of  manipulative  methods  was  Swedish  move- 


PRINCIPLES  OF  OSTEOPATHY  403 

ments.  These  introduced  leverage  and  voluntary  resistance 
as  new  factors  in  increasing  the  tone  of  the  neuro-mus- 
cnlar  apparatus.  A  very  limited  field  was  accorded  to 
massage  and  Swedish  movements.  Both  these  methods 
were  practically  never  used  except  as  prescribed  by  a 
physician.  Practically  no  diagnostic  ability  or  initiative 
is  credited  to  those  who  apply  the  methods.  Surgery  was 
"Formerly  that  branch  of  medicine  concerned  with  man- 
ual operations  under  the  direction  of  the  physician."  If 
the  evolution  of  surgery  can  be  used  as  a  criterion  for 
judging  the  future  of  manual  manipulation,  there  can  be 
no  doubt  as  to  the  commanding  position  that  will  be  at- 
tained. 

Osteopathy  has  introduced  a  new  factor  in  manipu- 
lative therapeutics,  i.  e.,  the  adjustment  of  joint  luxations 
and  subluxations.  It  is  interesting  to  note  that  the  art 
of  manipulation  applicable  to  this  corrective  work  was 
developed  independently  of  massage  and  Swedish  move- 
ments. Osteopathic  movements  could  not  have  evolved 
naturally  from  massage  and  Swedish  movements,  because 
osteopathic  technique  is  the  direct  result  of  the  theory, 
sturdily  asserted  and  defended  by  Dr.  A.  T.  Still,  that 
"Structure  governs  function."  His  recognition  and  treat- 
ment of  joint  lesions,  "subluxations",  led  to  the  develop- 
ment of  a  system  of  movements  primarily  surgical  in 
character.  No  matter  how  much  any  osteopathic  physi- 
cian may  take  issue  with  him*  in  matters  of  theory,  the 
fact  exists  that  not  one  of  them  believes  that  he  has  ever 
been  approached  in  skill  in  the  art  of  corrective  manipu- 
lation. 

Present  day  osteopathic  physicians  are  beneficiaries 
of  all  the  successes  credited  to  massage,  Swedish  move- 
ments. Dr.  A.  T.  Still's  original  work,  special  operations 
devised  by  orthopaedists  all  over  the  world,  and  the 
brilliant  work  of  Professor  Lucas  Champoniere  in  the 
treatment  of  fractures  by  "gluco-kinesis"  and  mobilisa- 
tion. We  are  beneficiaries  of  all  these  because  Dr.  Still 


404  PRINCIPLES  OF  OSTEOPATH Y 

believed  in  fundamental  medical  education  and  the  es- 
tahlshment  of  a  school  of  medicine  and  surgery  primarily 
devoted  to  the  scientific  development  of  manipulative 
therapeutics.  Since  at  the  time  of  his  most  active  work 
in  practice  and  teaching,  the  abuse  of  drugs  and  surgery 
was  at  its  height,  it  is  no  wonder  that  he  desired  to  estab- 
lish a  system  of  practice  which  would  not  be  burdened 
by  inheritance  of  the  foibles  and  failures  of  drug-therapy. 

As  a  result  of  the  success  of  osteopathic  theory  and 
practice,  there  has  been  the  inevitable  plagiarizing  of  its 
literature  and  methods  by  those  who  find  it  profitable  to 
impose  on  an  ignorant  public.  This  plagiarizing  has  been 
done  under  several  names,  but  especially  under  that  of 
chiropractic.  The  history  of  this  attempt  to  appropriate 
the  principles  and  methods  of  'osteopathy,  without  re- 
quiring any  creditable  educational  work  to  make  them 
safe  means  of  treating  ailing  human  beings,  is  a  sad  trav- 
esty on  the  standards  of  medical  education  in  this  coun- 
try. Under  our  present  laws  new  schools  of  medicine 
may  be  started  as  short  cuts  to  avoid  the  moderately 
severe  requirements  of  established  schools.  So  long  as 
this  is  possible,  there  will  continue  to  appear  "new  schools" 
exploiting  some  phase  of  established  methods  under  new 
names. 

Methods  of  Procedure. — Osteopathic  physicians  fre- 
quently differ  as  to  methods  of  procedure,  but  they  all 
work  according  to  the  same  principle.  For  instance,  a 
subluxation  of  a  vertebra  might  be  discovered  by  two 
osteopaths.  The  first  one  might  undertake  to  reduce  the 
subluxation  without  any  preliminary  work  on  the  mus- 
cles, believing  that  it  is  best  to  go  right  to  the  seat  of 
trouble  and  remove  it.  His  treatment  would  be  severe 
because  much  strength  would  be  required  to  overcome 
the  resistance  of  the  muscles  governing  the  articulation. 
The  second  one  might  spend  considerable  time  on  the 
preliminary  work  of  relaxing  the  muscles  of  the  articula- 
tion, increasing  flexibility,  reducing  sensitiveness,  etc., 


PRINCIPLES  OF  OSTEOPATHY 


405 


before  attempting  any  specific  reduction  of  the  lesion.  The 
ultimate  result  of  both  methods  would  be  alike.  The 
question  of  which  method  is  best  lies  wholly  with  the  in- 
dividual osteopath.  Some  like  to  put  forth  a  severe  effort 
for  a  short  time,  others  a  moderate  effort  for  a  longer  time. 
Outside  of  the  special  choice  of  the  osteopath,  lies  the 
business  one  of  satisfying  the  patient.  Severe  work  at 
the  outset  frightens  some  patients,  furthermore,  it  actual- 
ly bruises  some  of  them.  The  ultimate  result  of  the  treat- 
ment may  be  excellent,  but  the  patient  does  not. quickly 
forget  the  methods  used.  There  is  a  parallel  between  the 
immediate  after-results  of  a  severe  osteopathic  treatment 
and  surgical  shock.  This  shock  should  be  avoided  as 
much  as  possible. 


FIG.  162.     Relaxation  of  the  latissimus  dorsi. 


406  PRINCIPLES  OF  OSTEOPATHY 

The  movements  hereafter  pictured  and  described  are 
all  made  with  reference  to  structure  rather  than  function. 
Few  references  are  made  concerning  their  applicability  to 
special  diseases.  AYe  do  not  care  what  the  name  of  the 
disease  is.  The  groups  of  symptoms  which  make  up  the 
pictures  described  in  symptomatology  have  very  little 
significance  to  the  osteopath.  His  movements  are  not 
made  with  reference  to  a  named  disease,  but  to  a  faulty 
structural  condition.  The  structural  condition  may  be 
the  basis  for  the  physiological.  Function  does  affect  struct- 
ure. \Ye  are  not  to  lose  sight  of  this  fact.  Function 
may  be  perverted  by  bad  habits,  hence  our  therapeutics 
must  comprehend  the  hygienic  and  dietetic  side  of  life  as 
well  as  structural. 

Fvery  movement  herein  outlined  secures  a  definite 
effect  on  a  muscle,  or  is  used  to  affect  the  relation  of  bony 
parts. 

The  movements  made  to  affect  the  muscles  of  the 
back  and  spinal  column  are  based  upon  the  attachment  of 
the  muscles  and  the  leverage  they  exert  on  the  spinal 
column. 

Relaxation  of  the  Latissimus  Dorsi. — The  arrange- 
ment of  the  back  muscles  has  been  noted  in  the  chapter 
on  Positions  for  Examination.  In  order  to  relax  these 
muscles  in  their  natural  relations,  i.  e.,  from  superficial 
to  deep  groups,  we  begin  with  such  a  movement  as  will 
separate  the  extremities  of  the  most  superficial  muscles 
to  their  fullest  extent.  Fig.  162  illustrates  the  method  of 
relaxing  the  latissimus  dorsi.  One  hand  extends  the  arm 
to  its  fullest  extent,  the  other  hand  anchors  the  ilium.  It 
will  be  noted  that  the  lower  dorsal  and  lumbar  portions 
of  the  spinal  column  are  lifted  by  the  pull  of  this  muscle, 
Also  the  four  lower  ribs  are  raised.  The  intrinsic  effect 
of  this  stretching  movement  is  to  take  most  of  the  ten- 
sion out  of  the  muscle  itself  and  increase  the  amount  of 
metabolic  change  taking  place  within  it.  But  that  is  not 
what  is  primarily  intended.  The  intrinsic  effects  are  mere 


PRINCIPLES  OF  OSTEOPATHY 


407 


FIG.   163.     Relaxation  of  the  trapezius. 

incidents  in  the  physiological  life  of  the  muscle,  and  as 
such  are  found  following  all  kinds  of  muscular  movements. 
The  extrinsic  effects  are  what  concern  us  most;  the  effect 
upon  the  vertebrae  and  ribs,  the  change  in  the  form  of 
the  chest. 

There  are  three  uses  for  this  movement.  First,  as 
preparatory  to  work  upon  muscles  lying  beneath  it,  i.  e., 
purely  relaxing.  Second,  in  case  of  overlapping  by  any 
one  of  the  four  lower  ribs.  It  is  a  common  condition  to 
find  the  twelfth  rib  under  the  eleventh,  or  tenth  under 
eleventh.  The  pull  of  the  latissimus  dorsi  is  exerted  on 
all  alike,  hence  the  individual  ribs  are  brought  into  their 
proper  relations.  Relaxation  usually  allows  a  return  of 
the  faulty  position,  but  if  the  ribs  are  held  at  their  ex- 
tremities by  the  operator  for  a  few  seconds  after  relaxa- 
tion, the  intercostal  muscles  and  quadratus  lumborum  will 


403 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  164.     Relaxation 


dt-us  major  and   minor. 


be  filled  with  arterial  blood  which  tones  them.  The 
patient  should  be  directed  to  hang"  by  the  hands  several 
times  per  day  so  as  to  get  a  good  effect  on  the  position  of 
the  lower  ribs.  Third,  to  affect  lateral  curvature  of  the 
spine  in  the  lumbar  or  lower  dorsal  portion. 

Relaxation  of  the  Trapezius. — The  trapezius  is  an- 
other of  the  superficial  group  of  back  muscles.  Its  fibers 
are  so  variously  attached  that  several  movements  are  re- 
quired to  relax  all  its  divisions.  Fig.  163  illustrates  the 
method  of  grasping  and  holding  the  scapula  while  relax- 
ing the  trapezius.  The  scapula  is  rotated  on  the  thorax 
as  far  as  possible  toward  the  head  so  as  to  stretch  those 
fibers  extending  from  the  spine  of  the  scapula  to  the  sixth 


PRINCIPLES  OF  OSTEOPATHY  409 

and  twelfth  dorsal  spines ;  then  away  from  the  head  to 
affect  the  cervical  fibers,  then  away  from  the  spinal  column 
to  relax  the  short  fibers  between  the  upper  dorsal  spines 
and  scapula.  There  is  a  vast  difference  in  the  way  the 
scapula  can  be  moved  about  in  different  cases.  Those 
having  any  tendency  to  asthmatic  trouble  will  present  a 
very  fixed  scapula.  The  more  marked  the  asthmatic  con- 
dition is,  the  more  difficult  it  is  to  move  the  scapula. 
Pleurisy  and  lung  troubles,  especially  when  coughing  is 
frequent,  tend  to  hold  the  scapula  fixed.  Lifting  the 
patient's  body  above  the  table  by  the  scapula  gives  instant 
relief  in  many  cases  of  pleuritic  pain,  intercostal  neuralgia 
or  angina  pectoris.  This  result  is  explained  by  the  re- 
moval of  the  pressure  exerted  by  the  scapula  when  it  is 
held  too  close  to  the  thorax  by  contracted  muscles  which 
are  acting  reflexly.  A  subluxated  rib  is  usually  respon- 
sible for  the  pains  mentioned,  but  the  muscles  of  the 
scapula  are  partially  respiratory,  hence  act  in  connection 
with  disturbances  of  normal  rhythm  of  intercostal  mus- 
cles. The  pressure  of  the  scapula  helps  to  fix  the  whole 
chest  in  an  unyielding  condition.  That  which  was  at  first 
purely  helpful  in  character  becomes  in  itself  an  added 
irritant.  This  movement  or  series  of  movements  affects 
the  tone  of  the  muscle  fibers,  then  the  whole  respiratory 
process. 

Relaxation  of  the  Rhomboids. — In  the  second  group 
of  back  muscles  we  find  the  rhomboids,  major  and  minor, 
accessory  muscles  of  inspiration.  Fig.  164  illustrates  a 
method  of  stretching  these  muscles.  The  patient's  elbow 
is  placed  against  the  physician's  abdomen.  Pressure 
against  the  elbow  forces  the  scapula  back,  and  makes  its 
vertebral  border  prominent.  The  physician's  fingers  grasp 
this  border  securely,  and  then  lift  steadily  upward.  This 
movement  is  excellent  for  the  purpose  intended.  That 
which  has  been  written  concerning  the  trapezius  is  ap- 
plicable to  the  rhomboids.  Outside  of  the  intrinsic  effects 
on  the  muscle  and  on  respiration,  a  slight  effect  may  be 


410 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  165.     Relaxation  of  the  pectoralis  major  and  serratus  magnus. 

exerted  on  a  lateral  curve  in  the  interscapular  region.  It 
is  generally  used  as  preparatory  to  work  on  deeper  struc- 
tures. 

The  Pectoralis  Major  and  Serratus  Magnus. — Follow- 
ing these  movements,  where  general  thoracic  and  spinal 
relaxation  are  desired,  the  movement  illustrated  in  Fig. 
165  may  be  used.  It  affects  the  Pectoralis  Major  and 
Serratus  Magnus.  P>y  pushing  the  patient's  elbow  as  far 
back  as  possible,  the  scapula  is  approximated  to  the  spinal 
column,  hence  the  serratus  magnus  is  put  upon  a  ten- 
sion which  lifts  the  eight  upper  ribs.  The  pectoralis 
major  also  affects  the  upper  ribs.  The  physician's  hand 
on  the  angle  of  the  ribs  accentuates  the  expansion  of  the 


PRINCIPLES  OF  OSTEOPATHY 


411 


FIG.    166.     Relaxation  of  the   serratus  magnus  ana  some  Bores  of  the 
fourth  layer  of  dorsal  muscles. 


chest.  This  is  a  general  movement,  but  one  which  has  far- 
reaching  effects  upon  respiration  and  circulation.  It  is 
adaptable  to  many  specific  structural  defects  of  the  ribs. 
In  Fig.  166  the  physician  again  uses  the  humerus  and 
scapula  as  means  by  which  to  affect  the  spinal  column. 
The  left  hand  exerts  traction  on  the  muscles  above  the 
spine,  while  the  right  hand  and  arm  forces  the  patient's 
scapula  toward  the  head  and  spine.  The  movement  is 
made  to  enable  the  physician  to  relax  the  serratus  mag- 
nus and  some  of  the  fibers  of  the  fourth  layer  of  the  back. 
Slight  torsion  of  the  dorsal  spinal  column  is  also  secured. 

Quadratus  Lumborum. — The  relaxation  of  the  quad- 
ratus  lumborum  is  secured  according  to  Fig.  167.  In  all 
displacements  of  the  twelfth  rib,  it  is  necessary  to  secure 
a  free  circulation  in  the  muscles  attached  to  that  rib.  The 
fact  that  it  is  a  floating  rib  makes  its  position  dependent 


412 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   167.     Relaxation   of  the  quadratus  iumborum. 


on  the  tone  of  the  muscles  attached  to  it.  It  is  frequent- 
ly slipped  under  the  eleventh.  This  movement  separates 
them. 

Fig-.  168  is  in  some  respects  similar  to  the  movement 
illustrated  in  Fig".  166,  except  that  the  scapula  is  forced 
downward,  and  the  left  hand  is  able  to  work  through  the 
relaxed  superficial  muscles.  After  the  use  of  the  move- 
ments already  illustrated,  it  is  astonishing  how  easily  one 
can  work  upon  the  fourth  layer  or  examine  the  condition 
of  deep  structures. 

Erector  Spinae. — The  work  upon  the  fourth  layer 
should  be  done  according  to  Fig".  155.  The  fingers  are 
placed  between  the  muscles  and  the  spines  of  the  verte- 


PRINCIPLES  OF  OSTEOPATHY 


413 


FIG.  168.     Relaxation  of  the  lower  fibres  of  the  trapezius. 


brae  and  then  drawn  away  from  the  spines  in  such  a  man- 
ner as  to  stretch  the  muscles.  The  fingers  should  never 
be  allowed  to  slip  over  the  muscles.  Work  steadily  and 
deeply.  Do  not  move  the  fingers  over  the  skin.  When 
you  place  your  fingers,  compel  all  soft  tissues  beneath 
them  to  move  with  them.  In  this  way  you  secure  relaxa- 
tion of  the  erector  spinae  and  continuations,  take  out  sore- 
ness of  the  muscles,  and  prepare  for  specific  work  upon 
the  ribs  or  vertebrae. 

The  erector  spinae  is  rarely  contracted  throughout 
its  whole  length.  Your  work  should  be  centered  on  that 
portion  which  your  examination  has  demonstrated  to  be 
contracted,  either  as  a  result  of  visceral  disturbance,  os- 
seous subluxation,  strain  or  cutaneous  reflex  from  cold. 

Having  now  prepared  our  patient  for  specific  manipu- 
lation, we  will  note  the  results  to  be  obtained  on  the  gen- 
eral contour  of  the  spinal  column. 

Treatment  of  Simple  Kyphosis. — Fig.  169  illustrates 
one  of  the  simplest  methods  of  springing  a  spine  which  is 


414 


PklN'CIl'LKS  OK  OSTEOPATHY 


FIG.    lt>!».     Springing   a    uorso-lumbar   kyp'aosis. 


FIG.  170.     A  method  of  springing  a  lumbar  kyphosis. 


PRINCIPLES  OF  OSTEOPATHY 


415 


FIG.    171.     Springing  an  upper   dorsal   lorciosis 


kyphosed  at  the  junction  of  the  dorsal  and  lumbar.  The 
physician's  forearms  are  placed  against  the  patient's 
shoulder  and  ilium  while  the  ringers  rest  over  the  ky- 
phosed portion  of  the  spinal  column.  The  hands  draw  for- 
ward while  the  forearms  push  away.  Considerable  force 
can  be  exerted  in  this  way  on  slender  patients. 

Great  force  can  be  exerted  on  a  posterior  curve  of  the 
lower  dorsal  and  lumbar  portions  by  the  movement  shown 
in  Fig.  170.  This  movement  is  also  used  for  purposes  other 
than  corrective  of  structural  defects.  Since  the  leverage 
is  so  great,  it  is  quite  easy  for  the  physician  to  carry  it 
too  far.  The  result  is  an  active  congestion  of  the  lower 
portion  of  the  spinal  cord,  followed  by  excessive  activity 
of  the  nerve  centers  located  there.  In  giving  this  move- 
ment to  women,  ascertain  whether  pregnancy  exists.  If 


416  PRINCIPLES  OF  OSTEOPATHY 

so,  do  not  under  any  consideration  use  it.  The  center  for 
parturition  might  be  excited  by  it,  even  though  the  move- 
ment made  is  slight. 

There  is  practically  no  danger  in  this  movement  when 
intelligently  used,  except  in  the  case  of  pregnancy.  A 
slow,  steady  lift  made  while  the  physician  is  watching 
carefully  the  amount  of  resistance  offered  by  the  back 
will  usually  inhibit  the  excitement  of  the  centers  located 
in  the  lumbar  enlargement  of  the  spinal  cord.  The  slow- 
ness and  steadiness  of  the  movement  relaxes  the  muscles 
of  the  fifth  layer  and  secures  better  drainage  for  blood  in 
the  spinal  canal.  Xo  active  congestion  is  brought  on, 
hence  a  sedative  effect  is  gained.  Quick,  intense  execu- 
tion of  this  movement  has  frequently  a  reverse  effect,  be- 
cause the  sharp  strain  put  upon  the  muscles  results  in 
added  contraction,  active  congestion  and  obstruction  to 
good  drainage  of  the  spinal  canal.  These  conditions  re- 
sult in  functional  activity  of  those  organs  governed  by 
the  nerve  cells  in  the  lumbar  enlargement.  Active  con- 
gestion of  a  center  results  in  increased  function  of  the 
organ  governed  by  that  center. 

As  a  general  rule,  this  movement  is  contra-indicated 
for  any  purpose  but  that  of  correcting  a  structural  defect. 
The  reaction  of  many  patients  is  an  uncertain  quantity, 
hence  it  is  not  wise  to  use  this  treatment  for  purely  func- 
tional effects. 

As  a  result  of  the  ignorant  use  of  this  movement  by 
those  who  are  palming  themselves  off  as  osteopaths,  the 
author  knows  of  several  cases  where  dangerous  conditions 
were  brought  on. 

Lordosis  —  Upper  Dorsal.  —  An  anterior  curve,  or 
straightened  condition  of  the  spine  in  the  interscapular 
region,  is  rather  difficult  to  treat  on  account  of  inability 
of  the  physician  to  use  the  extremities  as  levers.  Fig.  171 
illustrates  a  method  of  applying  leverage  by  means  of  the 
cervical  vertebrae.  The  position  of  the  knee  on  the  spinal 


417 


FIG.  172.  Springing  an  upper  dorsal  lordosis.  The  leverage 
is  so  great  in  this  movement  that  the  operator  must 
exercise  great  discretion  in  its  use.  As  applied  by  a 
skillful  operator  it  is  exceedingly  satisfactory. 


418  PRINCIPLES  OF  OSTEOPATHY 

column  regulates  the  extent  of  the  force  of  the  movement. 
The  knee  is  the  weight  to  be  lifted,  the  spinal  column  is 
a  flexible  lever.  The  physician's  forearms  are  the  fulcrum, 
while  his  hands  apply  the  force  to  lift  the  weight  (the 
knee)  which  bends  the  lever  at  the  point  governed  by 
the  position  of  the  weight  and  fulcrum.  The  position  of 
the  physician's  hands  is  important,  because  the  cervical 
is  not  the  portion  of  the  spinal  column  we  desire  to  bend. 
If  the  hands  are  allowed  to  rest  close  to  the  head,  the 
force  exerted  is  nearly  all  spent  on  the  neck;  the  most 
flexible  part  of  the  spinal  column  is  affected — a  result  not 
desired.  Place  the  hands  as  nearly  over  the  cervical  and 
first  dorsal  spines  as  possible.  Since  the  junction  of  the 
dorsal  and  lumbar  segments  is  a  very  flexible  point,  the 
knee  should  be  located  higher. 

Fig.  172  illustrates  another  method  of  producing 
flexion  in  the  upper  dorsal  region.  The  leverage  in  this 
position  is  so  great  that  the  operator  must  exercise  cau- 
tion in  its  use.  The  operator  should  never  aim  to  over- 
come the  patient's  resistance  by  exerting  a  greater  force. 
The  patient  will  usually  relax  under  the  influence  of  a 
tetering  movement,  i.  e..  short,  gentle  application  of  the 
leverage. 

The  Possible  Variety  of  Movements  Which  Will  Se- 
cure the  Same  Results. — All  of  the  effects  described  may 
be  secured  by  movements  differing  from  those  outlined. 
The  author  desires  to  illustrate  the  application  of  osteo- 
pathic  principles.  It  is  believed  by  him  that  the  series  of 
movements  illustrated  have  the  virtue  of  directly  and 
forcibly  affecting  the  part  desired  without  using  up  too 
much  of  the  physician's  strength  in  their  application. 
\Yhcre  much  work  is  done  by  a  physician,  it  becomes  a 
vital  problem  with  him  how  to  conserve  his  own  strength. 
By  the  selection  of  those  movements  which  give  the  great- 
est leverage,  he  saves  himself. 


PRINCIPLES  OF  OSTEOPATHY 


419 


The  Head  and  Neck  as  a  Lever. — If  the  anterior  or 
straightened  condition  of  the  spine  is  very  marked  in  the 
upper  dorsal,  it  is  possible  for  the  physician  to  use  the 
head  and  neck  in  securing  his  leverage.  When  the  posi- 
tion of  the  spine  is  as  described,  the  spinal  muscles  in  that 
area  will  be  very  contracted.  The  vertebrae  will  be  held 
tightly  together,  thus  lessening  the  flexibility.  Loss  of 
flexibility  of  the  spinal  column  results  in  poor  circulation 
in  the  spinal  cord  with  consequent  perversion  of  the  ac- 
tivity of  the  physiological  nerve  centers  located  there. 
Congestion,  passive  type,  usually  exists  around  these  cen- 
ters when  drainage  is  interfered  with  by  these  contracted 
muscles. 

Lordosis  or  Kyphosis  May  Affect  a  Function  Similarly. 
— A  change  in  the  contour  of  the  spine,  either  anterior  or 
posterior,  may  result  in  the  same  disturbances  in  the 
peripheral  distribution  of  the  nerves  from  the  dis- 
torted section.  The  anterior  curve  in  the  interscapular 
region  usually  causes  the  ribs  to  droop,  which  occasions 
a  flat  chest.  The  thoracic  cavity  is  lessened,  hence  respira- 


FIG.  173.      Voluntary  treatment  of  an  upper  dorsal  lordosis. 


420  PRINCIPLES  OF  OSTEOPATHY 

tion  is  feeble.  People  with  flat  chests  may  develop  won- 
derful breathing  capacity  by  persistent  exercise.  The 
respiratory  muscles  lift  the  ribs.  Exercise  of  these  mus- 
cles will  increase  the  antero-posterior  diameter  of  the 
chest. 

AYhen  directing  a  patient  about  the  details  of  exercise 
to  increase  the  breathing  capacity,  do  not  fail  to  impress 
the  fact  that  a  full  round  chest  without  flexibility  is  just 
as  bad  a  condition  as  an  abnormally  flat  chest.  Flexibility 
is  the  keynote  of  health.  Those  exercises  which  merely 
increase  the  contracting  power  of  muscles,  without  at  the 
same  time  increasing  their  relaxing  power  are  not  health- 
ful. 

Examination  shows  that  whether  we  have  anterior  or 
posterior  conditions  in  the  interscapular  region,  the  spinal 
muscles  are  contracted.  The  patient's  power  to  relax  them 
is  lost.  The  patient  may  feel  tired  and  weak,  but  these 
muscles  will  not  cease  their  contraction.  The  rigidity  has 
passed  beyond  the  patient's  control. 

The  patient  can  do  something  toward  restoring  flexi- 
bility to  an  anteriorly  curved  or  straight  spinal  column 
in  the  upper  dorsal  region.  Fig.  173  illustrates  the  effect 
of  flexing  the  neck  forcibly  by  pulling  down  with  the 
hands.  These  spines  are  greatly  separated,  and  hence  the 
muscles  of  the  fourth  and  fifth  layers  are  relaxed. 

Fig.  174  illustrates  how  the  physician  can  use  the  dor- 
sal and  cervical  vertebrae  as  a  flexible  lever,  and  bv  shift- 
ing the  position  of  the  hand  upon  the  spine  apply  the 
movement  specifically  to  any  particular  vertebra.  No 
movement  which  uses  the  arms  as  levers  will  affect  the 
position  of  these  vertebrae,  because  the  first  and  second 
layers  of  muscles  which  are  affected  by  arm  movements 
do  not  control  the  intrinsic  mobility  of  this  portion  of  the 
spinal  column.  The  fourth  and  fifth  layers  of  back  mus- 
cles are  the  groups  which  cause  the  mal-position  of  verte- 
brae in  this  region. 


421 


FIG.    174.     Use  of   the  head  and  neck  as  a  flexible 
lever  10  afteci  the  upper  dorsal  region. 


Splenius  Capitis  et  Colli. — The  Splenius  Capitis  et 
Colli,  a  muscle  of  the  third  group,  extends  as  low  as  the 
sixth  dorsal  spine.  As  its  name  indicates,  it  is  a  bandage 
muscle,  and  binds  down  the  muscles  under  it.  Its  long- 
attachment  in  the  dorsal  region  gives  it  a  considerable  in- 
fluence there,  when  its  superior  attachments  to  the  head 
and  neck  are  forced  anteriorly  by  flexion  of  the  neck.  It  is 
the  influence  of  this  muscle  which  makes  the  movements 
described  so  effective.  These  movements  are  for  a  gen- 
eral corrective  effect  on  a  section  of  the  spinal  column. 


422 


PRINCIPLES  OF  OSTEOPATHY 


FKJ.    175.     A    method    of    affecting    kyphosis    in    the    upper    dorsal 

region. 


They   are  not   well   adapted  to  treatment  of  an  individual 
vertebra. 

Kyphosis — Upper  Dorsal. — A  posterior  curve  in  the 
upper  dorsal  region  can  be  treated  by  the  method  illus- 
trated in  Fig.  175.  The  physician's  right  arm  is  placed 
above  the  patient's  right  shoulder  and  under  the  chest,  so 
that  the  hand  can  be  placed  in  the  patient's  left  axilla. 
The  patient's  head  should  be  turned  away  from  the  physi- 
cian, so  that  the  upward  pressure  of  his  arm  will  not  inter- 
fere with  the  trachea.  The  physician's  left  hand  may  be 
moved  from  place  to  place  along  the  spinal  column.  The 
farther  the  hands  are  separated,  the  more  leverage  is 
gained.  Considerable  force  can  be  exerted  in  this  move- 
ment without  any  danger  to  the  patient,  in  fact,  to  be  of 
any  value  it  must  be  made  forcefully.  The  primary  use 
of  this  procedure  is  to  reduce  the  excess  of  posterior  curve. 


PRINCIPLES  OF  OSTEOPATHY 


423 


That  which  has  been  written  concerning  the  nerve 
centers  in  the  interscapular  region,  when  straightening  or 
anterior  curvature  of  the  spine  exists,  applies  equally  to 
the  posterior  curvature. 


FIG.    176.     A    method    of    affecting    kyphosis    in    the    dorso-lumbar 

region. 


424 


PRINCIPLES  OF  OSTEOPATHY 


Posterior  curvature  is  accompanied  by  increased  an- 
tero-posterior  diameter  of  the  chest,  and  loss  of  flexibil- 
ity. This  movement  increases  flexibility.  It  can  easily  be 
adapted  to  the  treatment  of  the  fifth  or  sixth  ribs. 


FIG.    177.     A    method    of    affecting    kyphosis    in    the    lower    dorsal 
region. 


PRINCIPLES  OF  OSTEOPATHY 


425 


Kyphosis — Dorso-lumbar. — When  the  kyphosis  is  at 
the  junction  of  the  dorsal  and  lumbar  regions,  it  is  easy 
to  secure  enormous  leverage.  The  arms  can  be  used  as 
levers  while  the  physician's  knee  rests  against  the  kypho- 
sis as  in  Fig.  176.  If  the  patient's  buttocks  are  held  to  the 
stool,  the  whole  force  of  the  leverage  is  spent  on  the  back 
under  the  physician's  knee.  This  movement  should  not 
be  carried  too  far.  It,  like  all  other  movements  in  which 
the  physician  has  tremendous  leverage,  is  liable  to  pro- 
duce more  than  the  desired  effect.  It  stretches  the  thorax 
and  abdomen  very  decidedly. 

Centra-indications. — The  author  expects  that  all  who 
use  this  and  other  high  power  movements,  have  examined 
their  patients  carefully  before  administering  them.  The 
presence  in  the  abdomen  of  an  aneurism,  ovarian  cyst,  or 


FIG.    178.     A   method    of  affecting   kyphosis   in   the   lumbar   region. 


426 


PRINCIPLES  OF  OSTEOPATHY 


gravid  uterus,  centra-indicate  the  use  of  any  movement 
which  compresses  the  abdominal  contents,  and  also  in  the 
case  of  a  gravid  uterus  any  movement  which  is  liable  to 
cause  active  congestion  of  the  lumbar  enlargement  of  the 
spinal  cord. 

Other  Movements. —  Fig.  177  illustrates  another  meth- 
od of  exerting  pressure  on  the  prominent  part  of  a  kypho- 
sis.  The  leverage  is  not  so  great  as  in  the  preceding 
method,  but  where  the  kyphosis  is  slight,  it  is  the  better 
movement. 

Still  another  simple  method  of  springing  the  lumbar 
portion  of  the  spinal  column  is  shown  in  Fig.  178.  The 
patient's  knees  arc  held  against  the  physician's  abdomen, 
while  the  physician's  hands  make  counter  pressure  over 
the  apex  of  the  kyphosis.  The  buttocks  are  forced  back- 
ward by  the  pressure  on  the  patient's  knees.  Some  osteo- 
paths object  to  this  movement  or  any  other  which  neces- 


FIG.   179.     A  method  of  affecting  either  kyphosis  or  lordosis  in  the 
lumbar  region. 


PRINCIPLES  OF  OSTEOPATHY  427 

sitates  pressure  of  the  patient's  knees  or  elbows  against 
the  abdomen.  There  is  an  element  of  danger  to  the 
osteopath. 

This  position,  Fig.  178,  is  used  frequently  where 
strong  inhibitory  pressure  in  the  lumbar  region  is  required. 
For  example,  in  cases  of  diarrhoea  or  cramps.  Any  hyper- 
activity  of  structures  governed  by  cells  in  the  lumbar  en- 
largement may  be  inhibited  in  this  region. 

When  lordosis  of  the  lumbar  region  exists,  it  is  neces- 
sary to  flex  that  region  in  order  to  counteract  it.  Fig.  179 
illustrates  an  easy  method  of  accomplishing  this  result. 

This  same  movement  with  the  physician's  right  hand 
under  the  spine  can  be  made  to  do  duty  in  correcting  a 
posterior  curve.  When  the  hand  is  placed  directly  under 
the  kyphosis,  the  back  is  lifted;  then  if  the  buttocks  be 
forced  to  the  table,  the  spine  will  be  sprung  in  the  direc- 
tion desired. 

Functional  Kyphosis. — A  large  proportion  of  patients 
whose  spinal  columns  exhibit  a  tendency  to  kyphosis,  in 
the  splanchnic  area,  suffer  from  either  visceral  reflexes  or 
a  hypotonic  condition  of  the  erector  spinae  muscles.  There 
is  scarcely  a  case  of  visceral  ptosis  that  does  not  present 
a  hypotonic  condition  of  these  extensor  muscles.  The 
functional  kyphosis  so  frequently  apparent  in  this  region 
is  tremendously  benefited  by  rather  forceful  leverage 
movements  which  are  accompanied  by  counter  pressure  at 
the  apex  of  the  kyphosis.  If  this  counter  pressure  is  ap- 
plied suddenly,  but  not  severely,  it  usually  produces  a 
sound  in  the  arthrodial  articulations  of  the  spinal  column 
under  the  point  of  counter  pressure.  This  popping  sound 
can  be  produced  by  a  variety  of  methods,  many  of  which 
are  illustrated  in  this  chapter.  The  patient  practically 
always  feels  an  increase  of  muscle  tone  after  the  popping 
sound  is  elicited.  This  is  evidenced  by  a  feeling  of  greater 
ability  to  hold  the  body  erect.  There  is  a  genuine  feeling 
of  increased  power,  aside  from  any  psychological  effect 


428 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    ISO.     A    method    of   securing   general    dorsal    rotation. 


that  may  accompany  the  phenomenon.  As  a  simple  ex- 
periment, one  may  voluntarily  extend  one's  fingers  in 
opening  the  hand  to  its  fullest  extent,  after  having  had  it 
flexed  for  a  considerable  time.  There  is  a  feeling  of  lim- 
itation of  the  extensor  movement  which  is  done  away  with 
if  we  passively  extend  the  fingers  with  the  other  hand. 
After  this  passive  extension  by  manipulation  we  are  able 
to  voluntarily  extend  the  fingers  with  greater  power  and 
to  a  greater  extent  than  before.  This  equalizing  of  the 
forces  of  extension  and  flexion  is  probably  what  takes 
place,  when  we  hear  the  sound,  incidental  to  movements 
which  produce  sudden  passive  extension,  in  a  joint  which 
is  in  a  state  of  imbalance  on  account  of  a  static  error,  or 
visceral  reflex. 


429 

Wherever  we  find  the  muscles  which  are  prime  movers 
of  a  joint  in  a  state  of  imbalance,  we  are  apt  to  produce  a 
sound  in  the  joint  when  we  exaggerate  the  movement  so 
as  to  suddenly  stretch  the  dominant  muscle  or  muscle 
group.  This  produces  a  readjustment  of  the  joint  sur- 
faces. Since  the  spinal  arthrodial  joints  are  apt  to  be  in 
a  state  permitting  spinal  flexion,  due  to  static  conditions, 
fatigue,  or  visceral  ptosis,  we  are  able  more  frequenlty  to 
produce  sounds  in  these  joints  than  in  most  others, 
when  sudden  correction  is  made  by  counter  pressure.  This 
phenomenon  of  sound  in  a  joint,  incidental  to  a  quick  re- 
adjustment of  its  joint  surfaces,  when  muscular  tension 
controlling  the  joint  is  equalized,  has  led  to  the  inven- 
tion of  many  ingenious  methods  for  producing  it.  Tables 
have  been  devised  of  various  heights,  having  adjustable 
pads  and  separable  sections  so  as  to  allow  the  patient  to 
lie  prone  across  openings  in  the  surface  of  the  table,  thus 
greatly  increasing  the  advantage  of  the  operator  in  mak- 
ing sudden  downward  pressure  on  a  selected  point  in  the 
spinal  column.  No  apparatus  is  necessary  to  enable  one 
to  do  efficient  adjusting  work  if  the  conditions  necessary 
for  the  production  of  the  popping  sound  are  understood. 


FIG.   181.     To   correct  rotation   in   lower  dorsal  and   lumbar   region 
and  secure   free  movement  of  the  lower  ribs. 


430 


PRINCIPLES  OF  OSTEOPATHY 


The  effort  to  produce  such  a  sound  in  all  so-called  sub- 
luxations  will  surely  result  in  strain  of  the  peri-articular 
tissues.  The  operator  must  have  a  trained  sense  of  tissue 
resistance  and  be  governed  accordingly.  Leverage  and 
counter  pressure  should  never  be  used  in  the  treatment 
of  any  joint  which  exhibits  symptoms  of  inflammation. 
In  case  of  inflammation  in  a  joint,  its  position  is  probably 
self-protective  and  hence  should  not  be  roughly  treated. 
The  lack  of  ability  to  diagnose  the  true  condition  of  a 
joint  leads  to  frequent  misuse  of  manipulative  methods. 

New  Schools. — It  is  astonishing  how  varied  a  class 
of  patients  is  benefited  by  rather  heavy  counter  pressure 
movements.  This  fact  has  led  to  the  rapid  exploiting  of  so- 
called  "new  schools"  which  claim  their  methods  are  differ- 
ent from  and  far  superior  to  osteopathic  methods.  It  is  an 
interesting  fact,  testified  to  by  many  patients  who  have  been 
treated  by  many  osteopathic  physicians,  that  no  two  of 
their  physicians  operated  alike.  This  is  characteristic,  in 
that  the  osteopathic  colleges  have  not  concentrated  so 
much  on  a  particular  method  as  on  teaching  principles 
which  are  capable  of  many  methods  of  application. 


FIG.    182.     Simplest   form   of  movement   to   overcome   a   functional 
kyphosis  in  the  dorsal  region. 


PRINCIPLES  OF  OSTEOPATHY 


431 


Various  Applications  of  a  Principle. — If  a  patient  with 
a  functional  kyphosis,  in  the  splanchnic  area,  lies  prone  on 
the  floor  or  any  other  unyielding-  surface,  as  in  Figs.  182 
and  183,  it  often  suffices  to  merely  make  sudden  down- 
ward pressure  on  the  apex  of  the  kyphosed  area  with  the 
palm  of  the  hand.  One,  or  several,  popping  sounds  will  be 
heard  if  the  patient  relaxes  and  the  force  of  the  sudden 
pressure  is  properly  proportioned  to  the  passive  resistance 
of  the  spinal  tissues.  It  may  be  necessary  to  concentrate 
the  point  of  pressure,  i.  e.,  use  a  thumb  or  heel  of  the  hand, 
reinforced  with  the  opposite  hand.  The  reason  some  op- 
erators use  low  tables  is  merely  to  allow  them  to  use 
their  own  weight  to  the  best  advantage  in  using  down- 
ward pressure.  According  to  the  extent  of  the  "lesioned 
area,"  i.  e.,  the  kyphosis,  and  according  to  the  voluntary 
power  of  relaxation  characteristic  of  the  patient,  the  op- 
erator can  use  a  large  or  small  contact  area,  i.  e.,  the  heel 
of  the  hand,  hypothenar  eminence,  or  the  thumb.  The 
amount  of  pressure  must  be  proportioned  to  the  passive 
resistance  of  the  tissues.  No  effort  should  be  made  to 


FIG.  183.  To  overcome  a  functional  kyphosis  in  the  upper  dorsal 
we  may  use  a  towel  as  a.  sort  of  fulcrum  while  making  sudden 
downward  pressure  over  the  transverse  processes  of  the  verte- 
brae with  the  thumbs.  This  movement  usually  causes  a  snap- 
ping sound  in  the  articulations  most  affected  by  the  thumb 
pressure. 


432 


PRINCIPLES  OF  OSTEOPATHY 


overcome  any  active  resistance  on  the  part  of  the  patient. 
The  operator  must  contrive  to  use  the  pressure  before  the 
patient  can  bring  his  muscles  into  active  contraction. 
Herein  lies  the  necessity  for  the  exercise  of  considerable 
discretion  as  to  when  the  advantage  of  the  patient's  off 
guard  moment  should  be  taken. 

The  Use  of  a  Fulcrum.— Advantage  over  a  patient's 
natural  spinal  resistance  is  gained  by  using  a  fulcrum  at 
some  chosen  point  on  the  anterior  surface  of  the  body.  A 
verv  simple  use  of  this  principle  is  illustrated  by  Fig.  184, 
wherein  the  operator's  forearm  serves  the  purpose  of  a  ful- 
crum. 

Figs.  185  and  186  illustrate  the  application  of  the 
same  principle  with  the  patient  sitting.  This  is  probably 
the  easiest  position  for  the  operator  to  use  counter  pressure. 
His  knees  serve  as  a  fulcrum.  His  hands,  grasping  the  pa- 
tient's elbows,  have  a  secure  hold,  so  that  a  sudden  pull 
backward  serves  to  force  the  weight  of  the  upper  portion 
of  the  patient's  bodv  over  the  fulcrum  and  thus  fulfill  the 
conditions  of  extension  and  counter  pressure  required  for 
correction  of  the  kyphosis.  l>v  varying  the  position  of  the 


FIG.  1S4.  To  correct  a  functional  kyphosis  in  the  dorsal  region. 
Operator  using  his  right  forearm  as  a  fulcrum.  Sudden  down- 
ward pressure  is  made  with  the  opposite  hand,  reinforced  by 
the  pressure  of  the  operator's  chest. 


PRINCIPLES  OF  OSTEOPATHY 


433 


PIG.  185.  To  correct  a  functional  kyphosis  in  the  dorsal 
region.  Patient  must  be  relaxed.  Operator  makes  a 
sudden  but  very  moderate  pull  against  his  knees. 


434  PRINCIPLES  OF  OSTEOPATHY 

operator's  knees  and  interlocking  his  fingers  over  the  pa- 
tient's chest,  as  in  Fig.  185,  the  movement  can  be  made 
very  specific  as  to  a  single  spinal  segment. 

A  movement  of  great  adaptability  is  illustrated  by 
Fig.  187.  The  patient  places  his  hands  on  opposite  shoul- 
ders and  then  allows  his  weight  to  rest  on  the  operator's 
forearm.  In  this  manner  the  operator  may  use  his  left 
or  right  hand,  according  to  convenience,  as  a  fulcrum  to 
be  applied  at  any  selected  point  in  the  dorsal  or  lumbar 
area.  l»y  lifting  the  patient's  body  against  the  fulcrum, 
either  suddenly  or  gradually,  the  operator  is  able  to  con- 
centrate corrective  leverage  and  pressure  at  any  desired 
point.  Rotation  of  the  spinal  column  can  be  secured  by 
this  movement  and  hence  it  serves  as  one  of  the  most 
adaptable  movements  for  all  sorts  of  corrective  work.  The 
operator  does  not  actually  carry  much  of  the  patient's 
weight  on  his  arm. 

The  first  four  dorsal  vertebrae  are  rather  difficult  to 
manipulate.  The  position  illustrated  by  Fig.  230  shows 
how  the  hypothenar  eminence  of  the  operator's  left  hand 
serves  as  a  fulcrum,  while  the  rest  of  the  hand  reinforces 
the  neck,  so  that  the  head  and  neck  thus  reinforced  can 
be  used  as  a  lever,  which  is  forced  backward  by  the  right 
hand  on  the  patient's  chin.  Fig.  189  shows  how  more  pow- 
erful leverage  may  be  applied,  by  one  who  has  a  keen  sense 
of  tissue  resistance.  Any  movement,  embodying  great 
leverage,  must  be  used  with  extreme  caution. 

Coordination  of  Corrective  Movements. — The  success 
of  any  of  these  movements  depends  entirely  on  the  oper- 
ator's ability  to  coordinate  his  movements  so  as  to  affect 
the  special  point  in  the  spinal  tissues  requiring  adjust- 
ment. Just  as  one's  eyes  coordinate  to  produce  binocular 
vision,  one's  hands  must  work  harmoniously  to  secure  good 
results.  The  skillful  operator  causes  practically  no  pain 
by  his  movements.  They  are  timed  and  graduated  to  suit 
the  needs  of  his  case. 

Fig.  191  illustrates  a  method  of  exerting  leverage 
and  pressure  to  correct  a  lateral  subluxation  in  the  upper 


PRINCIPLES  OF  OSTEOPATHY 


435 


FIG.  186.  To  correct  a  functional  kyphosis  in  the  dorsal 
region.  Practically  the  same  movement  as  in  preceding 
illustration.  By  transmitting  the  pull  through  the  pa- 
tient's arms,  the  patient's  pectoral  and  serratus  magnus 
muscles  lift  the  anterior  extremities  of  the  ribs.  This 
is  an  exceedingly  efficient  movement  when  executed  by 
a  skillful  operator. 


436  PRINCIPLES  OF  OSTEOPATHY 


FIG.  187.     An  excellent  movement  by  which  to  exert  leverage 
and   counter  pressure   in  the  dorsal  and   lumbar  regions. 


PRINCIPLES  OF  OSTEOPATHY 


437 


FIG.  188.  An  application  of  leverage  and  counter  pressure  to 
secure  corrective  rotation  in  the  dorsal  region.  By  con- 
centrating the  counter  pressure  the  rotation  can  be  ac- 
centuated in  a  single  articulation. 


438 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  189.  Using:  the  head  and  neck  as  a  lever  while  the 
hypothenar  eminence  of  the  right  nand  is  used  as  a 
fulcrum  in  the  upper  dorsal  region  or  by  using  the  thumb 
and  forefinger  as  the  fulcrum  the  force  of  the  move- 
ment may  be  exerted  to  correct  a  cervical  lesion. 


PRINCIPLES  OF  OSTEOPATHY  439 


FIG.  190.     A  variation  of  the  movement  pictured  in  the  pre- 
ceding illustration. 


440  PRINCIPLES  OF  OSTEOPATHY 

dorsal.  The  operator's  right  hand  serves  to  force  the  head 
and  neck  in  a  direction  to  bend  the  column  over  the  thumb 
of  the  left  hand,  as  a  fulcrum.  The  patient's  face  is  inclined 
toward  the  lesion  side,  so  as  to  accentuate  rotation,  which 
is  the  actual  corrective  part  of  the  movement. 

Dorsal  Rotation. — Fig.  181  is  a  simple  method  of  se- 
curing flexibility  in  the  lower  dorsal  portion  of  the  back. 
Rotation  is  possible  in  the  dorsal  but  not  in  the  lumbar 
region,  hence,  by  holding  the  shoulders  down  and  lifting 
one  hi]),  rotation  is  secured  in  the  dorsal  region.  This 
movement  forces  the  normal  action  between  individual  ver- 
tebrae of  the  lower  dorsal  region.  If  any  particular  articu- 
lation is  at  fault,  it  will  not  yield  to  such  a  general  move- 
ment as  this.  The  only  gain  made  by  it,  in  that  case,  is  to 
prepare  the  surrounding  tissues  for  more  specific  work. 

Lateral  Curvature. — This  kind  of  deformity  is  fre- 
quently found  and  a  large  proportion  of  such  cases  are  ben- 
efited by  osteopathic  manipulation.  A  weakened  con- 
dition of  the  whole  body  predisposes  to  the  formation  of 
a  lateral  curve.  Fig.  192  illustrates  an  uncompensated 
lateral  curve,  that  is.  the  curvature  is  all  in  one  direction. 
In  such  a  case  the  muscles  on  the  convex  side  are  not  doing 
their  full  duty.  The  patient  is  allowing  the  weight  of  the 
upper  portion  of  the  trunk  to  be  held  by  the  ligaments  in- 
stead of  the  muscles.  This  simple  curvature  can  be  readily 
overcome  by  exercises  which  will  develop  the  weak  spinal 
muscles. 

Fig.  134  illustrates  a  compensated  curve,  that  is,  a 
letter  S  curve.  The  primary  curve  is  in  the  interscapular 
region  and  is  compensated  for  by  a  curve  in  the  opposite 
direction  in  the  lumbar  region. 

Know  How  to  Apply  Principles.  —  The  osteopath 
should  know  how  to  apply  his  principles  so  thoroughly  that 
the  position  of  his  patient,  whether  lying,  sitting  or  stand- 
ing, will  not  confuse  him.  Some  osteopaths  desire  to  give 
their  manipulations  to  the  patient  sitting,  others  like  the 
reclining  position  better.  On  the  whole,  it  seems  best  to 
select  the  position  suited  to  the  special  work  required. 


PRINCIPLES  OF  OSTEOPATHY 


441 


FIG.  191.  Using  the  head  and  neck  as  a  lever,  reinforced  by 
the  operator's  right  nana  ana  arm,  while  the  operator's 
left  thumb  is  used  as  a  fulcrum  to  accentuate  the  force 
of  an  effort  to  correct  a,  rotated  upper  dorsal  vertebra, 
or  a  group  lesion. 


442 


PRINCIPLES  OF  OSTEOPATHY 


Do  Not  Copy  Movements.  —  Do  not  copy  anybody's 
movements.  Learn  the  principles,  then  apply  them  in  the 
manner  most  satisfactory  to  yourself  and  helpful  to  the 
patient.  To  understand  the  principles  and  apply  them 
intelligently,  one  cannot  know  too  much  concerning  all 
the  subjects  which  are  the  basis  of  a  broad  medical  edu- 
cation. 


FIG.  192.      A  case  of  uncompensated  lateral 
curvature,  due  to  debility. 


PRINCIPLES  OF  OSTEOPATHY  443 


CHAPTER  XXI. 

REDUCTION   OF   SUBLUXATIONS. 

Having  noted  a  few  movements  which  have  a  general 
beneficial  effect  on  groups  of  structures,  we  will  now  ex- 
amine a  few  of  the  movements  which  are  applicable  to 
specific  subluxations. 

In  the  chapter  on  Subluxation  in  the  theoretical  sec- 
tion of  this  volume,  we  called  attention  to  the  fact  that  "A 
subluxation  is  a  slight  abnormal  relation  between  bony 
surfaces,  maintained  by  uneven  contraction  in  opposing 
groups  of  muscles  which  control  the  articulation.  The 
causes  of  the  contraction  are  violence,  temperature  changes 
and  reflex  irritation.  A  reduction  is  secured  by  equalizing 
vital  activity."  With  this  statement  in  mind,  we  will  study 
first  the  lateral  subluxations  in  the  dorsal  region. 

Lateral  Subluxation. — A  lateral  subluxation  is  possible 
only  in  those  portions  of  the  spinal  column  where  the 
formation  of  the  articular  facets  allow  rotation.  The  cer- 
vical and  dorsal  are  the  regions  in  which  this  occurs.  Lat- 
eral subluxation  is  most  common  in  the  articulations  of 
the  atlas,  third  cervical,  and  anywhere  in  the  dorsal  with 
the  exception  of  the  twelfth.  The  inferior  articular  facets 
of  the  twelfth  are  lumbar  in  character,  hence  allow  only 
flexion,  extension  and  circumduction. 

It  makes  no  difference  what  the  cause  of  the  lateral 
subluxation  may  be,  the  uneven  contraction  of  muscles 
is  the  final  result,  hence  all  are  treated  in  the  same  manner. 

When  the  vertebral  spine  is  discovered  out  of  line  with 
those  above  and  below  and  tenderness  noted  on  its  prom- 
inent side,  we  are  disposed  to  consider  it  a  true  lesion,  an 
irritant  to  the  nervous  system.  Whether  it  is  the  result  of 


444 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    1!)3.     Suil'iice    indication    of   a    lateral    subluxation. 

accident,  cold  or  reflexes  does  not  need  to  be  seriously 
considered.  While  it  exists,  it  is  a  continual  source  of  ir- 
ritation to  the  nervous  system,  hence  should  be  removed 
without  delay.  If  it  is  the  result  of  reflexes,  its  reduction 
will  at  least  remove  one  disturbing  factor  from  the  case. 

The  prominent  side  of  the  spine  is  the  one  on  which 
the  muscles  are  contracted.  The  contracted  muscles  must 
be  those  which  arc  holding  the  bone  in  its  mal-position. 
In  order  to  exert  this  influence,  they  must  be  attached  in 
such  a  way  as  to  move  the  bone  in  this  direction  when 
they  act  normally.  Their  present  condition  is  one  of  hyper- 
activity.  With  this  line  of  reasoning,  any  articulation  can 
be  examined,  the  pull  of  its  muscles  determined  and  move- 


PRINCIPLES  OF  OSTEOPATHY 


445 


FIG.   194.     "Exaggeration"   of  a  lateral  subluxatlon. 

ments  made  in  accordance  with  the  normal  action  of  these 
muscles. 

In  Fig-.  193  we  observe  the  subluxation  to  the  left  of  a 
mid-dorsal  vertebra.  Intrinsic  rotation  of  the  dorsal  spines 
is  the  result  of  the  contraction  of  the  rotatores  spinae,  one 
of  the  fifth  group.  In  order  for  this  vertebra  to  remain 
subluxated,  i.  e.,  more  rotated  than  any  of  its  fellows,  the 
particular  digitation  of  the  rotatores  spinae  attached  to  it 
must  remain  contracted,  after  the  other  digitations  have 
become  relaxed.  The  work  laid  out  for  us  is  relaxation  of 
this  one  digitation.  The  digitation  which  is  acting  is  work- 
ing from  below,  i.  e.,  arises  from  the  transverse  process 
of  the  vertebra  below  the  one  which  is  subluxated. 

The  first  movement  consists  in  "exaggerating  the  le- 
sion." The  patient's  body  is  flexed  laterally  away  from  the 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    195.     "Flexion"   of   a  lateral   subluxation. 

prominent  side  of  the  lesion  as  in  Fig.  194.  This  procedure 
stretches  the  contracted  rotatores  spinae  and  also  sep- 
arates the  three  vertebrae,  i.  e.,  the  subluxated  one  and 
the  superior  and  inferior  ones,  thus  making  it  easier  to 
push  the  subluxated  vertebra  into  its  true  position. 

The  second  movement  is  an  anterior  flexion  to  permit 
of  greater  freedom  of  movement  between  the  articular  pro- 
cesses. By  forcing  the  body  first  into  the  position  of  lateral 
flexion,  then  anterior  flexion,  all  the  muscles  of  the  fifth 
group  which  affect  the  subluxated  vertebra  are  relaxed. 
During  this  anterior  flexion,  a  "click"  is  sometimes  heard 
which  is  evidence  of  relaxation  sufficient  to  allow  approxi- 
mation of  the  subluxated  surfaces.  During  all  the  time  of 


PRINCIPLES  OF  OSTEOPATHY 


447 


FIG.    196.     Extension   and    counter   pressure    to   re- 
duce a  lateral  subluxation. 


making  these  flexions,  the  physician's  right  thumb  should 
make  steady  pressure  against  the  prominent  side  of  the 
spine,  thus  taking  advantage  of  the  relaxation  gained  by 
each  flexion.  The  anterior  flexion  is  illustrated  in  Fig.  195. 

The  final  movement  is  lateral  flexion  toward  the  lesion 
while  lifting  the  patient  from  the  stool  in  such  a  way  that 
the  weight  of  the  body  below  the  lesion  exerts  its  influence 
to  separate  the  vertebrae.  Fig.  196.  Counter  pressure  with 
the  thumb  is  made  vigorously  during  this  final  movement. 

The  successful  reduction  of  this  subluxation  may  be 
accomplished  without  any  "click"  or  other  evidence  of 
movement  of  the  surfaces.  The  vertebra  usually  moves 
into  its  true  position  without  any  audible  sign.  The  physi- 


448 


PRINCIPLES  OF  OSTEOPATHY 


clan's  fingers  can  determine  the  success  or  failure  of  the 
movement.  If  the  subluxation  was  caused  by  accident  or 
cold,  its  reduction  is  all  that  is  needed,  but  if  it  is  the  re- 
sult of  reflex  irritation,  originating  in  a  viscus,  the  physi- 
cian must  direct  such  a  mode  of  living  that  rest  may  be 
secured  for  the  stimulated  viscus.  Habits  of  life  must  be 
looked  into. 

Fig.  1(J~  illustrates  another  method  of  reducing  a  slight 
lateral  subluxation.  The  physician's  left  arm  passes  under 
the  patient's  left  axilla,  then  the  hand  is  placed  firmly  on 
the  base  of  the  neck  posteriorly.  This  gives  the  physician 
great  leverage.  The  physician's  knee,  right  or  left,  is 
placed  against  the  spinal  column  at  a  point  four  or  five 


FIG.    197.     Leverage   applied   to   a   lateral   subluxation    in   the    mid- 
dorsal  region. 


PRINCIPLES  OF  OSTEOPATHY 


449 


inches  below  the  stiblnxation.  This  compels  the  flexible 
spinal  column  to  yield  to  the  force  applied  at  the  neck,  in 
such  a  way  as  to  relax  the  deep  muscles  controlling  the 
subluxation.  Counter  pressure  applied  to  the  prominent 
spine  by  the  physician's  right  thumb  completes  the  move- 
ment. By  this  movement  about  the  same  result  is  ob- 


FIG.   198.     Leverage  applied  to  a  lateral  subluxation  in  the  lower 
dorsal   region. 


450  PRINCIPLES  OF  OSTEOPATHY 

taincd  as  when  counter  extension  is  given  by  two  men 
pulling  at  the  head  and  feet  of  the  patient,  while  a  third 
one  devotes  his  attention  to  forcing  the  vertebral  spine 
into  place.  \Yhen  the  patient  is  short  and  heavily  muscled, 
it  is  impossible  to  execute  this  movement  satisfactorily. 

Lateral  Subluxation — Lower  Dorsal. — A  lateral  lesion 
of  the  ninth,  tenth  or  eleventh  dorsal  is  more  easily  han- 
dled than  those  higher  up,  because  the  physician  can 
grasp  the  patient  in  a  much  more  satisfactory  manner. 
Fig.  1(AS  illustrates  the  method. 

The  series  of  movements  is  always  the  same  as  al- 
ready described,  that  is,  lateral  flexion  or  "exaggeration," 
anterior  flexion,  then  lateral  flexion  toward  the  lesion,  as 
illustrated  by  the  cut. 

AYith  this  same  position,  other  forms  of  subluxation  in 
the  lower  dorsal  and  lumbar  regions  can  be  corrected. 

A  Depressed  Spine. — Slight  depression  of  a  dorsal 
spine  with  sensitiveness  over  it,  that  is,  between  its  apex 
and  the  spine  below,  indicates  that  the  muscles  in  that 
situation  are  sufficiently  contracted  to  draw  the  spine  of 
the  upper  vertebra  downward.  The  depressed  spine  indi- 
cates that  the  body  of  the  vertebra  is  slightly  tipped  back- 
ward and  downward.  See  chapter  on  Subluxations. 

To  reduce  this  lesion,  a  flexion  of  the  spinal  column 
as  far  as  the  vertebra  below  the  lesion  is  made  anteriorly. 
If  the  depressed  spine  is  any  one  of  the  upper  six  dorsal, 
use  the  pull  of  the  splenius  capitis  et  colli,  i.  e.,  flex  the 
head  and  neck  as  in  Fig.  174.  The  physician's  right  hand 
is  placed  on  the  spine  of  the  vertebra  below  the  subluxa- 
tion. thus  allowing  all  the  force  of  the  movement  to  ter- 
minate in  a  pull  on  the  muscles  between  this  vertebra  and 
the  depressed  spine.  This  same  principle  can  be  applied 
to  all  portions  of  the  spinal  column. 

YYhen  individual  spines  are  prominent  and  sensitive- 
ness is  found  above  the  process  instead  of  below,  we  have 
a  condition  the  reverse  of  that  just  described.  Its  treat- 
ment is  similar  to  that  of  the  preceding,  except  that  by 


PRINCIPLES  OF  OSTEOPATHY 


451 


changing  the  position  of  the  right  hand  to  rest  upon  the 
prominent  spine,  our  leverage  affects  the  contracted  mus- 
cles above  the  spine. 

Kyphosis — Pott's  Disease. — Whenever  a  "knuckle"  is 
found  in  the  spine,  inquire  carefully  as  to  the  possibility 
of  direct  injury,  predisposition  to  tuberculosis,  etc.  Pott's 


Fig.  199.     Spreading  the  lower  ribs  and  stretching  the  diaphragm. 


452  PRINCIPLES  OF  OSTEOPATHY 

disease  of  the  spinal  column  may  cause  prominence  of  a 
single  vertebral  spine.  As  other  vertebrae  are  affected,  a 
kyphosis  is  developed. 

Rib  Subluxations. — Rib  subluxations  present  many 
difficulties  to  the  osteopath.  The  methods  used  in  their 
reduction  are  as  varied  as  can  well  be  imagined.  A  few 
of  the  most  useful  and  direct  are  given  here. 

In  Fig.  199  the  physician  is  applying  a  method  of 
spreading  the  lower  ribs.  \Yhen  the  tenth  rib  sinks  under 
the  ninth  and  there  is  a  general  jamming  of  the  four  lower 
ribs  together,  the  physician  stands  behind  the  patient  who 
raises  his  hands  above  his  head  to  spread  the  lower  ribs 
by  means  of  the  latissimus  dorsi.  While  the  hands  are 
elevated,  the  physician  grasps  the  anterior  extremities  of 
the  ribs  and  holds  them  up  while  the  patient  lowers  his 
hands  to  his  thighs.  Such  a  movement  as  this  will  replace 
the  ribs  in  their  right  relations,  but  a  flexion  of  the  patient's 
body  will  undo  the  work.  Continual  well  directed  treat- 
ment and  voluntary  exercise  are  needed  to  bring  them  to 
place  and  hold  them  there. 

The  four  lower  ribs  can  be  separated  and  the  antero- 
posterior  diameter  of  the  thorax  increased  by  the  method 
illustrated  in  Fig.  200. 

The  left  hand  lifts  on  the  angles  of  the  depressed  ribs 
while  the  patient's  arm  is  extended  beyond  his  head,  thus 
making  use  of  the  leverage  gained  through  the  attachment 
of  the  latissimus  dorsi.  This  movement  increases  the  right 
and  left  hypochondriacal  spaces. 

The  position  of  an  individual  rib  is  affected  by  the 
contraction  of  the  intercostal  muscles  above  and  below  it. 
The  spacing  determines  whether  the  rib  is  elevated  or  de- 
pressed. The  width  of  an  intercostal  space  will  not  be  the 
same  between  the  angles  and  anterior  extremities.  This 
is  caused  by  the  fact  that  the  head  of  the  rib  is  fixed  so 
that  it  cannot  move  up  or  down.  The  movement  which 
takes  place  between  the  head  of  the  rib  and  the  vertebra 


PRINCIPLES  OF  OSTEOPATHY 


453 


FIG.   200.     Spreading  the  lower  ribs  by  using  the  latissimus  clorsi. 

is  a  slight  rotation.  The  costo-transverse  articulation  al- 
lows a  slight  gliding  of  the  articular  facet  of  the  rib  upon 
that  of  the  transverse  processes.  As  an  example,  take  the 
fifth  rib,  when  the  space  between  it  and  the  fourth  rib  is 
lessened  by  the  contraction  of  the  fourth  intercostals.  The 
lower  margin  of  the  rib  becomes  prominent  because  the 
rib  is  twisted  when  raised.  The  anterior  extremity  is  de- 
pressed, making  the  fourth  intercostal  space  wider  anter- 
iorly. Palpation  of  this  rib  in  this  condition  will  show  a 
prominent  angle  with  corresponding  depression  of  the  an- 
terior extremity.  When  the  rib  is  depressed  at  the  angle, 
its  anterior  extremity  will  be  prominent. 

Palpation  is  the  only  method  of  discovering  these  sub- 
luxations.  To  reduce  them,  the  same  principle  we  applied 
to  reduction  of  vertebral  subluxations  must  be  applied 
here,  i.  e.,  the  relaxation  of  the  contracted  muscles. 


454 


PRINCIPLES  OF  OSTEOPATHY 


The  tendency  in  asthmatic  and  bronchitic  patients  is 
to  cause  elevation  of  the  ribs,  thus  developing  a  barrel- 
shaped  chest.  When  all  the  intercostal  muscles  act  equal- 
ly, the  ribs  are  equally  spaced,  but  in  a  case  of  bronchitis, 
some  local  portion  of  the  bronchial  tubing  is  especially 


FIG.    201.     First  position   to  reduce  a   subluxated   fifth   rib. 


PRINCIPLES  OF  OSTEOPATHY 


455 


irritated.  From  this  area,  irritant  impulses  reach  the  spinal 
center  with  which  it  is  most  closely  associated.  The  inter- 
costal muscles  in  direct  relation  with  this  center  receive 
a  greater  number  of  impulses,  hence,  contract  more  vigor- 
ously. A  strain  or  blow  might  cause  the  same  result. 


FIG.   202.     Second   position    to   reduce   a  subluxated  fifth   rib. 


456  PRINCIPLES  OF  OSTEOPATHY 

To  bring  this  fifth  rib  down  to  its  proper  position,  the 
physician  may  stand  behind  his  patient,  as  is  illustrated 
by  Fig.  201.  ITis  left  hand  grasps  the  patient's  right  elbow 
and  pushes  it  above  the  shoulder,  thus  causing  the  mus- 
cles to  lift  the  ribs.  This  movement  will  pull  on  all  the 
ribs  of  the  right  side,  and  tend  to  equalize  the  spacing. 
The  physician  places  his  left  knee  directly  over  the  angle 
of  the  fifth  rib.  his  right  hand  on  the  anterior  extremities 
of  the  fifth,  sixth  and  seventh  ribs,  the  middle  finger  of 
this  hand  being  applied  against  the  lower  margin  of  the 
fifth  rib.  The  rib  being  now  in  right  relation  with  its  fel- 
lows, the  critical  period  of  the  movement  is  when  relaxa- 
tion is  allowed  by  lowering  the  arm.  The  knee  above  and 
over  the  angle,  pressing  forward  and  downward,  while 
the  middle  finger  of  the  right  hand  prevents  depression 
of  the  anterior  extremity.  This  leverage  forces  the  rib 
to  retain  right  relations  with  its  fellow  in  relaxation  of 
the  chest.  The  termination  of  the  movement  is  illustrated 
by  Fig.  202. 

A  general  depression  of  all  the  angles  of  the  ribs 
causes  their  superior  margins  to  be  prominent.  A  flat  chest 
is  the  result.  This  condition  frequently  follows  pneumo- 
nia or  some  disease  which  causes  the  patient  to  lie  on  the 
back  during  a  long  period  of  weakness. 

When  a  single  depressed  rib  is  found,  it  usually  has 
been  caused  by  a  strain  which  has  weakened  the  inter- 
costal muscles  in  the  space  above  it.  Treat  it  while  stand- 
ing in  front  of  the  patient.  Place  the  middle  finger  of  the 
left  hand  under  the  angle.  The  patient's  right  elbow 
may  rest  against  the  physician's  abdomen.  Pressure  made 
on  the  elbow  forces  the  scapula  back  and  brings  into  ac- 
tion the  serratus  magnus  which  lifts  the  ribs.  Ask  the 
patient  to  inspire  and  this  will  raise  all  the  ribs.  When 
relaxation  comes  with  expiration,  lift  the  angle  of  the  rib 
forcefully,  and  it  will  regain  its  proper  position.  Fig.  203 
illustrates  this  movement.  Some  osteopaths  grasp  the 


PRINCIPLES  OF  OSTEOPATHY 


457 


FIG.    203. 


The    position    of   the   fingers   below    the   angle    of   a   de- 
pressed rib. 


patient's  right  wrist  and  extend  the  arm  first  forward, 
then  above  the  head,  and  back  to  the  side,  instead  of  placing 
the  patient's  elbow  against  the  abdomen. 

It  will  be  noted  that  all  these  movements  are  based 
on  the  effects  of  muscular  contraction  and  relaxation  with 
resulting  changes  of  the  position  of  the  structures  to  which 
they  are  attached. 


458 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  204.     First  position  in  lifting  a  series  of  depressed  lower  ribs. 

Figs.  204,  205  and  206  illustrate  the  method  of  raising 
and  spreading  the  lower  ribs.  "\Yith  the  patient  in  this 
position,  the  physician  can  make  extensive  passive  move- 
ments without  much  resistance.  These  movements  are 
similar  to  that  illustrated  by  Fig.  199. 

\Yhen  the  ribs  "droop"  to  a  marked  degree,  there  is  a 
decided  change  in  the  shape  of  the  diaphragm.  The  extent 
of  the  thoracic  floor  is  lessened,  and  it  may  be  that  the 
structures  passing  through  the  diaphragm  are  detrimental- 
ly affected  by  it.  The  movement  pictured  in  Fig.  199  is 
well  calculated  to  spread  the  lower  ribs  and  thereby  in- 
crease respiratory  capacity. 


PRINCIPLES  OF  OSTEOPATHY 


459 


The  first  rib  is  so  strongly  held  by  the  scalenus  anti- 
cus  that  it  practically  never  is  depressed.  It  is,  however, 
frequently  elevated  to  such  an  extent  that  it  infringes  on 
structures  around  the  first  thoracic  sympathetic  ganglion, 
thus  affecting  heart  action. 

To  depress  the  first  rib  to  its  proper  position,  it  is 
necessary  to  take  the  extra  contraction  out  of  the  scalenus 


FIG.    205.     Second   position    in   lifting   a   series   of   depressed    lower 

ribs. 


460 


PRINCIPLES  OF  OSTEOPATHY 


anticus.  This  is  done  by  making  the  first  rib  a  fixed  in- 
stead of  a  movable  attachment.  Fig.  218  illustrates  the 
method  of  relaxing  the  scalenus  anticus.  The  physician's 
thumb  holds  the  first  rib  down  while  the  muscle  is  stretched 
by  forcing  the  patient's  head  directly  to  the  opposite  side. 
The  scaleni  muscles  can  be  easily  detected  by  placing 
one's  fingers  on  the  side  of  the  neck  near  the  base.  They 
will  be  felt  hardening  during  inspiration. 


FIG.   206.     The  third  position  in  lifting  a  series  of  depressed  lower  ribs. 


PRINCIPLES  OF  OSTEOPATHY  461 

Luxations  of  the  Innominate  Bones. — Examination  of 
the  innominate  bones  requires  very  close  observation  of 
all  the  factors  concerned  in  tilting  the  pelvis  and  varying 
the  length  of  the  lower  extremities. 

The  only  way  to  determine  the  condition  of  the  in- 
nominates  is  by  palpation  and  mensuration.  Have  the 
patient  stripped  and  sitting  in  a  perfectly  upright  position 
on  a  level  surface.  Determine  the  condition  of  the  lum- 
bar portion  of  the  spinal  column.  Have  the  patient's  shoul- 
ders level.  While  the  patient  is  in  this  position  the  rela- 
tive prominence  of  the  posterior  superior  iliac  spines  can 
be  noted  by  palpation.  Find  the  second  sacral  spine  and 
note  the  relations  of  the  iliac  spines  to  it.  They  should 
all  be  on  a  level.  See  Fig.  91  in  Chapter  XIII.  Palpate 
for  sensitiveness  around  the  iliac  spines,  crests  of  the  ilia 
and  crests  of  pubes.  Measure  from  the  anterior  superior 
iliac  spines  to  the  adductor  tubercles  on  the  internal  con- 
dyles  of  the  femur,  when  the  patient  rests  evenly  in  the 
dorsal  position.  This  measurement  is  not  entirely  satis- 
factory, because  any  change  in  the  thigh  muscles  or  hip 
rotators  may  easily  vary  the  measurements.  The  only 
fixed  structures  from  which  a  reckoning  can  be  made  are 
the  second  sacral  and  posterior  superior  iliac  spines.  The 
relations  between  the  sacrum  and  ilium  are  never  greatly 
changed,  therefore  it  requires  the  examiner  to  exclude 
practically  all  measurements  which  might  be  varied  by 
muscular  tension. 

The  posterior  superior  iliac  spine  may  be  less  prom- 
inent than  its  fellow  on  the  opposite  side,  or  vice  versa. 
There  may  not  be  enough  upward  or  downward  displace- 
ment to  make  a  well  recognized  change  in  horizontal  re- 
lations with  the  second  sacral  spine.  This  being  the  case, 
it  is  decidedly  difficult  to  determine  which  side  is  normal 
and  which  is  abnormal.  Hyperaesthesia  will  have  to  be 
depended  on  to  determine  this  point.  The  related  sub- 
jective symptoms  of  the  patient  will  decide  which  is  the 
affected  side. 


462 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    2u7.     Position   for   treatment  of  an   upward   and   forward   dis- 
location   of   the    iiium. 


The  shock  which  is  transmitted  to  this  articulation  in 
an  accident  usually  strikes  the  tuber  ischii  from  below,  or 
posteriorly,  or  strikes  the  knee  and  the  force  is  exerted 
against  the  ascetabulum.  "\Yhen  the  force  is  against  the 
tuber  ischii  from  below,  or  posteriorly,  we  have  an  upward 
displacement,  or  a  twist,  causing  the  posterior  superior 
iliac  spine  to  become  more  prominent.  When  the  force 
strikes  the  ascetabulum  by  means  of  the  femur,  the  twist 
is  in  the  opposite  direction,  and  the  spine  is  less  prominent. 

Have  the  patient  give  details,  if  possible,  concerning 
his  position  with  reference  to  the  direction  of  the  force  at 
the  time  of  the  accident,  or  if  the  condition  appears  to  be 
due  to  other  causes,  strive  to  find  out  what  they  are. 

Having  determined  the  direction  of  the  twist,  the  force 
of  our  manipulation  must  be  made  counter  to  that  applied 
at  the  time  of  the  accident.  Since  the  hip  joint  is  very 
movable,  we  cannot  use  the  thigh  as  a  stiff  lever,  there- 
fore, our  force  must  be  applied  to  either  the  anterior  or  pos- 
terior surface  of  the  tuber  ischii  and  to  the  anterior  or 


PRINCIPLES  OF  OSTEOPATHY  463 

posterior  superior  spine  of  the  ilium,  i.  e.,  push  and  pull, 
such  as  turning-  a  wheel  on  its  axle.  This  movement  is 
illustrated  in  Fig.  207.  The  original  force  which  this  move- 
ment is  trying  to  overcome  was  transmitted  from  the  knee 
by  the  femur  to  the  acetabulum,  and  resulted  in  a  twist 
of  the  ilium  which  made  the  posterior  superior  spine  less 
prominent  than  its  fellow  of  the  opposite  side.  In  order 
to  make  this  movement  effectual,  an  assistant  must  make 
steady,  even  pressure  over  the  articulation  of  the  sacrum 
and  fifth  lumbar  vertebra,  i.  e.,  overcome  the  tendency  of 
the  twisting  movement  to  merely  affect  the  movable  sacro- 
vertebral,  instead  of  the  immovable  sacro-iliac  articulation. 

By  flexing  the  patient's  thigh  on  to  his  abdomen,  suf- 
ficient opportunity  is  given  the  physician  to  make  pres- 
sure on  the  anterior  surface  of  the  tuber  ischii,  and  pull 
forward  on  the  posterior  superior  iliac  spine,  thus  revers- 
ing the  movement  illustrated  by  Fig.  207. 

Fig.  208  illustrates  an  effort  to  use  the  thigh  as  a  lever 
to  affect  the  sacro-iliac  articulation  when  the  posterior 
superior  spine  is  prominent.  This  is  a  dangerous  move- 
ment, and  should  not  be  used.  The  force  transmitted  by 
the  thigh  as  a  lever  will  not  reach  the  joint  desired,  and 
will  only  result  in  straining  the  ilio-femoral  ligament. 

A  sacro-iliac  subluxation  is  difficult  to  correct,  because 
the  joint  is  practically  without  normal  movement.  The 
pelvis  tends  always  to  resist  any  appreciable  movement  in 
its  joints,  therefore  the  physician  must  devise  ways  of 
securing  leverage  to  directly  affect  these  joints  without 
transmitting  his  corrective  leverage  through  the  very 
movable  sacro-vertebral  joint  above  or  the  hip  joint  below. 
This  is  a  difficult  condition  to  fulfill. 

Anterior  Rotation  of  the  Ilium. — When  the  ilium  is 
rotated  forward,  the  posterior  superior  spinous  process  is 
less  prominent  than  its  fellow  of  the  opposite  side.  This 
condition  can  be  met  by  having  the  patient  prone  on  an 
unyielding  surface,  slightly  padded  so  as  not  to  bruise 
the  anterior  superior  spine  of  the  ilium.  Since  the  twist 


464 


PRINCIPLES  OF  OSTEOPATHY 


dangerous    method    of    applying    force    to    the    sacro- 
iiiac   articulation. 


FIG.  209.  To  correct  anterior  rotation  of  the  ilium.  Hard  pad- 
ding under  the  anterior  superior  spine  of  the  ilium.  Sudden, 
heavy,  downward  pressure  on  the  sacrum  between  its  first 
spinous  process  and  the  iliac  spine,  on  the  lesion  side. 


PRINCIPLES  OF  OSTEOPATHY  465 

may  be  considered  as  an  ilium  rotated  forward  or  the  sac- 
rum rotated  backward,  we  may  meet  the  conditions  neces- 
sary for  correction  by  making  sudden  pressure  on  the 
sacrum  at  a  point  between  the  first  sacral  spine  and  the 
crest  of  the  ilium.  This  point  lies  sufficiently  above  the 
axis  of  rotation  in  the  sacro-iliac  articulation  to  give  the 
operator  some  leverage  to  assist  in  securing  .reduction  of 
the  subluxation.  The  operator  should  use  the  hypothenar 
eminence  of  one  hand,  reinforced  by  the  other  hand,  to 
make  contact  with  the  proper  area  on  the  back  of  the 
sacrum.  The  pressure  must  be  exerted  in  a  direction  par- 
allel with  the  iliac  crest.  After  contact  has  been  made  with 
the  hand  the  operator  should  prepare  to  deliver  a  sudden 
forceful  pressure,  as  though  he  was  trying  to  compress  a 
very  stiff  spring  which  would  not  show  any  compression 
without  throwing  his  weight  on  it.  It  may  be  necessary 
to  increase  the  operator's  advantage  by  putting  a  special 
pad  under  the  anterior  superior  spine  of  the  ilium  so  as 
to  eliminate  any  support  by  the  soft  tissues  of  the  ab- 
domen. A  further  advantage  may  be  gained  by  allowing 


FIG.  210.  To  correct  anterior  rotation  of  the  ilium.  Flex  thigh, 
on  the  lesion  side,  onto  the  abdomen.  Use  padded  edge  of 
operating  table  to  support  the  sacrum  at  point  between  first 
sacral  spine  and  spine  of  the  ilium,  while  a  sudden,  heavy 
downward  rotating  pressure  is  made  on  the  thigh  and  lesioned 
ilium. 


466  PRINCIPLES  OF  OSTEOPATHY 

the  patient's  leg,  on  the  side  of  the  lesion,  to  hang  of?  the 
table  so  as  to  be  at  a  right  angle  to  the  spinal  column. 
This  tends  to  tilt  the  pelvis  backward  and  thus  permit  a 
greater  downward  movement  in  response  to  the  sudden 
pressure.  Sometimes  it  is  advisable  to  use  several  par- 
tial applications  of  the  pressure  before  the  final  corrective 
effort,  without  removing  the  contact  hand.  This  tends 
to  permit  the  patient  to  relax  by  taking  away  the  feeling 
that  protective  resistance  must  be  made.  The  operator 
must  create  and  recognize  the  psychological  moment  for 
the  application  of  the  corrective  movement. 

The  principle  underlying  the  operation  just  described 
can  be  applied  if  the  patient  lies  on  his  back.  The  leg 
on  the  lesion  side  should  be  flexed  on  the  thigh  and  the 
thigh  on  the  abdomen,  thus  tilting  the  pelvis  backward. 
By  placing  the  pelvis  so  that  the  ilium  on  the  lesion  side 
is  just  off  the  padded  edge  of  the  table,  the  operator  can 
place  his  chest  against  the  flexed  leg  and  thigh  while  his 
hands  rest  on  the  opposite  anterior  superior  spines  of  the 
ilia.  A.  sudden  downward  pressure,  coordinated  with  an 
attempt  to  spread  the  ilia  apart,  will  be  met  by  the  re- 
sistance of  the  padded  edge  of  the  table  against  the  side 
of  the  sacrum,  between  its  first  spinous  process  and  the 
iliac  crest.  These  movements  have  the  advantage  of  ap- 
plying corrective  force  without  having  any  of  that  force 
dissipated  by  passing  it  through  a  movable  joint  before 
reaching  the  intended  point  of  application.  This  is  a  very 
important  factor  if  the  patient  is  anaesthetized. 

Posterior  Rotation  of  the  Ilium. — \Yhen  the  posterior 
superior  spine  of  one  of  the  ilia  is  apparently  too  prom- 
inent, care  should  be  taken  to  note  whether  the  apparent 
prominence  is  not  due  to  a  rotation  and  tilting  of  the  pel- 
vis in  its  relation  to  the  spinal  column.  Since  the  flexion 
of  the  trunk  on  the  pelvis  is  characteristic,  in  the  sitting 
posture,  and  all  people  tend  to  rest  themselves  while  stand- 
ing by  transmitting  the  weight  of  the  body  through  one 
leg,  continued  maintenance  of  these  positions  changes  the 


PRINCIPLES  OF  OSTEOPATHY 


467 


relation  of  the  pelvis  to  the  spinal  column,  i.  e.,  causes  a 
unilateral  lumbo-sacral  subluxation.  Static  errors  are 
characterized  by  a  compensatory  tilt  of  the  pelvis,  hence 
all  the  factors  that  might  produce  such  a  condition  must 
be  taken  into  consideration.  As  previously  noted,  the  one 
test  of  whether  a  subluxation  exists  is  a  comparison  of  the 
relative  positions  of  the  posterior  superior  spines  with 
relation  to  the  second  sacral  spine. 

To  correct  a  posterior  rotation  we  use  practically  the 
same  position  and  leverage  required  to  correct  a  tilt  of 
the  pelvis  on  the  spinal  column.  The  patient  should  re- 
cline on  the  normal  side,  thus  presenting  the  subluxation 
area  to  the  operator.  Force  must  be  applied  on  the  crest 
and  side  of  the  ilium  close  to  the  posterior  superior  spine, 
so  as  to  rotate  the  ilium  forward.  The  body  must  be  ro- 
tated backward,  thus  tending  to  hold  the  sacrum  from  ro- 
tating idly  with  the  ilium.  These  conditions  can  be  ful- 
filled if  the  operator  takes  the  position  illustrated  in  Fig. 
211,  i.  e.,  grasps  the  patient's  elbow  with  his  hand  and 
presses  his  own  elbow  against  the  patient's  shoulder,  thus 


FIG.  211.  To  correct  posterior  rotation  of  the  ilium.  Balance  pa- 
tient's body  in  the  lateral  recumbent  position  so  that,  by  push- 
ing the  patient's  shoulder  backward  the  operator  can  make 
efficient  pressure  against  the  prominent  iliac  spine  with  his 
opposite  forearm  and  thus  secure  a  combination-  extension  and 
torsion  movement,  concentrated  in  the  sacro-iliac  joint. 


468 


PRINCIPLES  OF  OSTEOPATHY 


securing  an  advantageous  hold  for  forcing  the  patient's 
body  to  rotate  backward.  The  operator  places  his  other 
forearm  solidly  against  the  crest  of  the  ilium  and  gluteal 
tissues  just  above  and  external  to  the  posterior  iliac  spine. 
l>y  rocking  the  pelvis  forward  and  the  body  backward  a 
few  times  the  patient  will  yield  to  the  movement  and  the 
operator  should  select  the  moment  of  the  patient's  greatest 
relaxation  to  suddenly  accentuate  these  opposing  rota- 
tions. \o  attempt  should  be  made  to  make  more  than  a 
moderate  rotation  until  it  is  felt  that  the  patient  is  per- 
mitting the  movement  to  be  made  without  interposing  any 
strong  protective  muscle  tension.  It  is  quite  impossible 
to  correct  a  subluxated  ilium  if  the  patient  exerts  any  pro- 
tective contraction  of  his  muscles.  The  force  of  the  rota- 
tion movement  must  go  through  the  muscles  without  re- 
sistance, so  as  to  reach  the  ligaments  and  other  deep  struc- 
tures around  the  joint.  The  art  of  getting  successfully 
by  the  muscular  tension  of  the  patient  without  exerting 
a  force  capable  of  producing  trauma  requires  no  small 
degree  of  skill.  No  great  amount  of  force  seems  ever  to 
be  required  if  one  has  a  fine  sense  of  tissue  resistance. 


FIG.  212.  Leverage  and  counter  pressure  to  reduce  a  posterior 
iliac  subluxation.  Operator's  left  forearm  makes  pressure 
against  posterior  superior  il'ac  spine.  Same  leverage  as  in 
P^ig.  21S,  therefore  dangerous. 


PRINCIPLES  OF  OSTEOPATHY  469 

By  working  skillfully  in  applying  corrective  force  one 
learns  to  recognize  a  psychological  moment  when,  by  in- 
tensifying the  force  suddenly,  the  deep  structures  which 
are  the  object  of  our  operation  can  receive  the  full  benefit 
of  our  effort  without  interference  from  muscular  contrac- 
tion. The  operation,  at  the  climax  of  the  application  of 
the  corrective  force,  is  characterized  by  a  popping  sound. 

The  position  here  described  serves  in  an  almost  iden- 
tical manner  for  treating  unilateral  subluxations  in  the 
lumbar  arthrodials  or  the  lumbo-sacral  articulation.  The 
only  change  required  is  the  shifting  of  the  forearm  from 
the  ilium  to  some  selected  point  higher  on  the  crest  and 
lumbar  region.  Since  the  lumbar  arthrodials  face  nearly 
directly  inward  and  outward,  the  forcing  of  the  shoulders 
and  pelvis  in  opposite  directions  tends  to  take  out  tension 
in  the  muscles  controlling  these  joints  and  the  force  is  evi- 
dently applied  with  the  same  angle  of  incidence  to  the  sur- 
faces of  the  lumbar  arthrodials  as  we  secure  in  the  dor- 
sal area  of  the  spinaj  column  by  a  sudden  counter  pressure 
and  extension. 

After  a  successful  correction  has  been  made  of  a  case 
of  subluxated  innominate  it  is  advisable  to  reinforce  the 
pelvic  ligaments  by  strapping  the  pelvis  with  surgeon's 
adhesive  plaster.  Plaster  three  inches  wide  serves  very 
well.  Apply  the  first  strip  so  that  its  upper  edge  just 
reaches  the  posterior  superior  spine  of  the  ilium.  Pass  the 
strip  forward  so  that  it  comes  just  above  the  crease  at  the 
junction  of  the  thigh  and  the  abdomen,  the  upper  margin 
of  the  strip  covering  the  anterior  superior  spine  of  the 
ilium.  The  pubic  hair  must  be  shaved  so  that  the  ends 
of  the  adhesive  strip  may  lap  over  the  pubes.  The  second 
and  third  strips  are  brought  around  the  body  on  lines  sim- 
ilar to  the  first  and  overlapping  each  other  about  an  inch. 
The  strips  should  be  put  on  tightly  so  as  to  bind  the  pelvis 
and  give  the  patient  a  sense  of  security  and  comfort.  The 
strips  may  be  left  on  for  ten  days,  then  a  series  of  treat- 
ments of  a  tonic  character  which  will  serve  to  strengthen 


470 


PRINCIPLES  OF  OSTEOPATHY 


the  tissues  is  advisable.  It  may  be  necessary  to  repeat 
the  corrective  movements  many  times  if  the  case  is  one  of 
low  vitality  or  has  a  static  area  which  does  not  permit  the 
pelvis  to  hold  its  normal  relation  to  the  spinal  column. 


FIG.  213.  Three  strips  of  two  and  one-half-inch  adhesive 
applied  to  reinforce  the  pelvic  ligaments  so  as  to  retain 
a  subluxated  ilium  in  position  after  correction. 


PRINCIPLES  OF  OSTEOPATHY  471 


CHAPTER  XXII. 

TREATMENT  OF  THE  CERVICAL  REGIOX. 

The  treatment  of  the  clavicle  must  be  considered  here, 
because  its  position  so  frequently  interferes  with  the 
drainage  of  the  tissues  of  the  neck.  When  it  is  held  down 
too  closely  to  the  first  rib,  by  shortening  of  the  subclavius 
muscle,  it  is  quite  sure  to  affect  venous  circulation  in  the 
head  and  neck. 

To  Raise  the  Clavicle. — To  raise  it  place  the  right 
thumb  on  the  first  rib  as  illustrated  by  Fig.  214,  then  carry 
the  patient's  left  forearm  across  his  face  above  the  head 
as  in  Fig.  215.  Then  as  far  outward  as  the  physician's 
arm.  This  movement  causes  the  clavicle  to  press  down 
on  the  physician's  thumb,  where  it  rests  on  the  first  rib, 
and  thus  stretches  the  subclavius. 

Subluxation  of  the  Clavicle. — Articulations,  such  as 
the  sterno-clavicular  and  acromio-clavicular,  which  depend 
entirely  on  their  ligaments  to  keep  them  together  and  to 
limit  their  nrotion,  cannot  be  retained  in  place  if  their  liga- 
ments have  been  injured.  If  the  ligaments  of  the  sterno- 
clavicular  joint  become  relaxed,  the  pull  of  the  sterno- 
cleido-mastoid  lifts  it  upward.  Slight  irritation  of  the 
pneumogastric  nerve  may  be  occasioned  by  this  change  of 
position. 

Preparatory  Treatment  of  the  Neck — Trapezius. — The 
preparatory  treatment  of  the  neck  consists  in  movements 
to  relax  the  various  groups  of  muscles.  Fig.  216  illustrates 
the  method  of  relaxing  the  cervical  portion  of  the  trape- 
zius.  One  hand  on  the  shoulder  holds  it  firmly  down,  while 


472 


PRINCIPLES  OF  OSTEOPATHY 


PIG.    214.     First   position   to   raise  me   oiavicie. 

the  other  hand  forces  the  head  as  far  as  possible  in  the 
opposite  direction.  Relax  the  opposite  muscle  in  a  similar 
manner. 

Sterno-cleido-mastoid. — Next,  relax  the  sterno-cleido- 
mastoid  by  separating-  its  attachments  as  far  as  possible, 
as  in  Fig.  217,  also  by  direct  manipulation.  Observe 
whether  both  muscles  will  relax  equally.  These  large  mus- 
cles are  frequently  found  unevenly  contracted.  Since  the 
spinal  accessory  nerves  control  these  muscles,  any  con- 
traction should  lead  the  physician  to  examine  all  parts 
in  connection  with  them.  A  reflex  from  the  laryngeal 
branches  as  well  as  pncumogastric  branches  might  ac- 
count for  it. 


PRINCIPLES  OF  OSTEOPATHY 


473 


FIG.    215.     Second   position  to  raise   the   clavicle. 

Scaleni. — The  scaleni  muscles  should  be  treated  as  al- 
ready mentioned  in  Chap.  XXI.  See  Fig-.  218. 

Splenius  Capitis  et  Colli. — Fig.  219  illustrates  a  meth- 
od of  stretching  the  ligamentum  nuchae,  as  well  as  all  the 
extensor  muscles  on  the  back  of  the  neck.  This  may  be 
modified  by  forcing  the  chin  backward  with  one  hand, 
while  the  other  flexes  the  head  as  sharply  as  possible.  This 
stretches  the  muscles  and  ligaments  on  the  posterior  por- 
tion of  the  occipital-atlantal  and  axial  articulations.  The 
retraction  of  the  chin  governs  the  amount  of  stretching 
exerted  by  the  flexion. 


474 


PRINCIPLES  OF  OSTEOPATHY 


FIG.   216.     Relaxation   of  the  cervical  fibres  of  the   trapezius. 

Extension. — Direct  extension  of  the  neck  makes  an 
equal  pull  on  all  the  vertebrae.  When  the  patient's  feet 
are  anchored,  the  force  of  the  pull  is  felt  in  the  weakest 
portions  of  the  spinal  column.  The  average  patient  requir- 
ing this  treatment  enjoys  a  delicious  stimulation  after  re- 
laxation of  the  extension.  A  few  who  are  extremely  ner- 
vous may  give  a  bad  reaction.  The  influx  of  blood  in  the 
spinal  cord  is  highly  beneficial  to  those  who  have  suffi- 
cient vaso-motor  tone  to  hold  it  there,  but  those  who  lack 
this  tone  will  feel  faint  or  even  absolutely  lose  conscious- 
ness. Simply  allowing  them  to  rest  on  the  table  until  the 
vascular  system  reacts,  will  enable  them  to  reap  the  full 
benefit  of  the  treatment.  The  extension  should  be  made 
with  absolute  steadiness.  The  relaxation  period  is  usually 
the  one  in  which  any  vaso-motor  phenomena  are  noted. 


PRINCIPLES  OF  OSTEOPATHY 


475 


FIG.   217.     Relaxation  of  the  sterno-cleido-mastoid. 


The  tension  should  be  lessened  very  slowly  in  all  cases. 
Fig.  220  shows  the  position  of  the  physician's  hand. 

Rotation. — The  following  movement  is  one  for  which 
long  practice  is  required,  in  order  to  get  anything  like  a 
successful  result  from  its  use.  It  consists  in  grasping  the 
patient's  neck  with  the  left  hand  as  in  Fig.  221.  The  pa- 
tient's head  rests  against  and  slightly  to  the  right  of  the 
physician's  forearm.  The  right  hand  grasps  the  chin  while 
the  forearm  rests  firmly  against  the  patient's  head.  The 
object  is  to  hold  the  neck  and  head  rigid  above  the  point 
grasped  by  the  thumb  and  fingers  of  the  left  hand.  While 
holding  the  head  and  neck  rigid,  they  are  moved  so  as  to 
force  circumduction  in  the  joint  below  the  grasp  of  the 
left  hand.  After  each  circumduction  the  left  hand  is  shifted 
the  depth  of  one  vertebra  nearer  the  head.  Thus  all  the  in- 
tervertebral  articulations  in  the  cervical  region  are  relaxed 


476 


PRINCIPLES  OF  OSTEOPATHY 


Kid.    21S.     Relaxation    of    the    scaieni    by    depressing    the    first    rib. 

and  specific  work  on  a  definite  articulation  can  be  done 
more  easily. 

The  Hyoid  Bone. — \York  on  the  anterior  portion  of 
the  neck  consists  in  affecting  the  condition  of  groups  of 
muscles  forming  the  floor  of  the  mouth  and  extrinsic  mus- 
cles of  the  larynx. 

The  Hyoid  bone  is  the  movable  part  which  can  be 
grasped  by  the  physician's  fingers.  Drawing  it  downward 
and  to  the  right,  as  in  Fig.  222,  relaxes  the  stylo-hyoid  and 
posterior  belly  of  the  digastric.  A  contractured  condition 
of  these' muscles  may  affect  the  pneumogastric  nerve. 

Mylo-hyoid  and  Hyoglossus. — The  mylo-hyoid  and 
hyoglossus  forming  the  floor  of  the  mouth  may  be  treated 
as  in  Fig.  223.  When  the  maxillary  glands  are  congested, 


PRINCIPLES  OF  OSTEOPATHY 


477 


FIG.   219.     Relaxation  of  the   splenius   capitis   et   colli. 

it  is  necessary  to  relax  these  muscles.  The  physician's 
right  hand  grasps  the  hyoid  bone,  being  careful  to  provide 
enough  loose  skin  above  the  bone  so  that  the  force  will 
not  be  exerted  on  the  cutaneous  tissues  instead  of  the 
muscles  underneath.  After  the  hyoid  bone  is  pulled  down- 
ward, the  tension  of  the  mylo-hyoid  is  increased  by  using 
the  pressure  of  the  fingers  of  the  left  hand. 

Sterno-thyroid  and  Sterno-hyoid. — The  depressor  mus- 
cles of  the  larynx  and  hyoid  may  be  stretched  by  forcing 
these  structures  toward  the  angle  of  the  jaw,  while  the 
free  hand  makes  direct  manipulation  of  the  muscles.  In 
all  cases  of  congestion  of  the  glands,  mucous  membranes 
or  cellular  tissues  of  the  mouth,  pharynx  or  larynx,  these 
muscles  should  be  relaxed  if  the  position  of  the  atlas  has 
been  corrected. 


478 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    220.     Extension   of   the   neck. 


Intrinsic  Muscles  of  the  Larynx. — The  intrinsic  mus- 
cles of  the  larynx  sometimes  need  attention.  The  crico- 
thyroid  is  the  tuning-  muscle  of  the  larynx.  This  may  be 
demonstrated  by  grasping  the  thyroid  cartilage  with  the 
thumb  and  forefinger  of  one  hand,  while  the  thumb  and 
forefinger  of  the  other  hand  grasps  lightly  the  cricoid 
cartilage,  as  in  Fig.  224.  If  the  cartilages  are  slightly  sep- 
arated while  the  patient  makes  a  vowel  sound,  the  pitch 
of  the  voice  will  be  perceptibly  lowered.  This  is  occa- 
sioned by  relaxation  of  the  vocal  cords  by  separating  the 
cartilages,  which  stretches  the  crico-thyroid.  This  mus- 
cle is  innervated  by  the  external  branch  of  the  superior 
laryngeal  branch  of  the  pneumogastric.  The  motor  fibers 
of  the  superior  laryngeal  come  from  the  spinal  accessory, 
hence  we  find  lesions  in  the  cervical  articulations,  which 
are  primary  causes  of  laryngeal  disorders. 


PRINCIPLES  OF  OSTEOPATHY  - 


479 


FIG.   221.     Circumduction  of  the  neck  to  relax   the  muscles  of  the 
fifth    layer. 


The  Atlas. — The  atlas,  on  account  of  its  position,  free- 
dom of  movement,  numerous  muscular  attachments,  etc., 
is  subject  to  frequent  subluxation.  Fig.  102  shows  the 
normal  relations  of  the  mastoid  process,  transverse  pro- 
cess of  the  atlas,  and  the  angle  of  the  jaw.  Fig.  103  shows 
the  abnormal  relations  of  these  various  prominent  points 
as  they  are  frequently  found  by  the  osteopath.  When 
the  right  transverse  process  is  near  the  mastoid,  the  left 
is  too  close  to  the  angle  of  the  jaw,  and  vice  versa. 

In  reducing  this  twist  of  the  atlas,  the  physician 
should  work  on  the  side  whiqh  shows  the  transverse  pro- 
cess to  be  posterior.  The  same  principle  is  applied  in  re- 
ducing this  subluxation  as  was  described  in  connection 
with  the  dorsal  lateral  subluxations.  Fig.  225  illustrates 
"exaggeration."  Fig.  226  shows  lateral  flexion  to  the  left, 
while  the  physician's  fingers  make  firm  pressure  back  of 
the  prominent  transverse  process,  thus  steadily  taking 


480 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    222.     Relaxation    of    the    stylo-hyoid    and    posterior    belly    of    the 

digastric. 

advantage  of  all  the  relaxation  gained  in  each  portion  of 
the  movement.  The  termination  of  the  movement  is  il- 
lustrated in  Fig.  227.  Sometimes  the  atlas  slips  into  place 
with  an  audible  "click,"  but  more  often  the  physician  feels 
a  "gritting"  sensation  as  the  articular  surfaces  rub  over 
each  other.  When  the  subluxation  of  the  atlas  is  reduced 
by  this  movement,  it  will  hold  its  true  position  more  firmly 
than  will  any  other  vertebral  articulation  which  has  been 
affected  in  a  like  manner.  This  is  because  the  condyles 
of  the  occiput  fit  more  deeply  into  the  superior  articulat- 
ing surfaces  of  the  atlas  than  is  the  case  between  articulat- 
ing surfaces  of  pairs  of  vertebrae.  Fig.  229  illustrates  a 


PRINCIPLES  OF  OSTEOPATHY 


481 


FIG.    223.     Relaxation   of   the   mylo-hyoid   and   hyo-giossus. 

method  of  relaxing  the  muscular  tension  in  the  muscles 
which  move  the  atlas.  This  method  is  used  to  force  the 
atlas  forward.  It  will  be  readily  noted  that  by  over-ex- 
tending" the  head  on  the  neck  and  using  counter  pressure 
on  the  posterior  surface  of  the  atlas  the  mechanical  re- 
quirements for  forcing  the  atlas  forward  are  fulfilled.  By 
moving  the  head  up  and  down  and  from  side  to  side,  mus- 
cular tension  will  be  sufficiently  reduced  to  permit  reduc- 
tion of  the  subluxation. 

Sixth  Cervical. — The  sixth  cervical  vertebra  is  especial- 
ly difficult  to  treat.  When  the  cervical  muscles  are  well 
developed,  it  is  obscured  to  the  touch  posteriorly,  but  the 
carotid  tubercles  anteriorly  can  be  felt.  It  is  not  wise  to 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    224.     Relaxation   of   the   crico-thyroid. 


exert  much  pressure  upon  bony  structures  from  the  an- 
terior surface  of  the  neck.  There  are  so  many  glands, 
nerves,  arteries,  etc.,  lying  over  the  transverse  processes, 
that  direct  pressure  is  liable  to  injure  them. 

Fig.  228  illustrates  a  method  of  reducing  a  subluxation 
of  the  sixth  cervical  vertebra.  The  patient's  chin  rests  in 
the  physician's  hands,  which  are  placed  on  each  side  of  the 
neck  and  near  enough  to  the  chin  to  support  it  by  the 
little  finger.  The  thumbs  are  used  to  affect  the  spine 
directly.  The  compression  of  the  head  and  neck  above 
the  lesion,  by  both  hands,  keeps  them  rigid  and  all  are 
moved  together,  first  to  exaggerate  the  lesion  of  the  sixth, 
then  anterior  flexion  is  forced  in  the  articulation  affected, 
then  lateral  flexion  with  counter  pressure  by  the  thumb 
on  the  prominent  side  of  the  spine. 


PRINCIPLES  OF  OSTEOPATHY 


483 


FIG.    225.     Reduction   of   subiuxation   of  the   atlas,    right   trans- 
verse  process   too   tar   posterior — exaggeration    movement. 


This  movement  can  be  applied  to  subluxations  of  the 
first  and  second  dorsal. 

General  Principles  Underlying  Corrective  Movements. 
—The  same  general  principle,  governing  the  correction  of 
subluxations  in  other  portions  of  the  spinal  column,  is 
applicable  in  the  cervical  region,  i.  e.,  the  movement,  or 
series  of  movements,  must  be  made  so  as  to  overcome  the 
influence  of  a  dominant  muscle  group.  As  we  have  pre- 


484 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    226.     Reduction    of    subluxation    of    the    atlas,    lateral    flexion. 

viously  noted,  the  position  of  an  arthrodial  joint  is  expres- 
sive of  the  relative  tension  of  the  muscles  which  activate  it. 
The  Simplest  Form  of  Correction. — The  simplest  form 
of  corrective  movement  is  extension,  i.  e.,  a  direct  pull  in 
the  long  axis  of  the  spinal  column.  This  tends  to  put 


PRINCIPLES  OF  OSTEOPATHY 


485 


FIG.    227.     Reduction    of    subluxation    of    the    atlas,    extension    and 
counter   pressure. 

equal  stress  on  all  the  joints,  but,  in  reality,  it  will  be  felt 
most  in  any  lesioned  articulation.  The  lesioned  articula- 
tion is  the  "weakest  link"  and  therefore  is  most  sensitive 
to  the  effect  of  the  extension.  Extension  of  this  kind  is 
grateful  to  most  patients  and  when  made  by  one  who  has 
a  keen  sense  of  tissue  resistance,  is  practically  without 
danger. 


486 


PRINCIPLES  OF  OSTEOPATHY 


FIG.    22S.     Manner    of    holding    the   head    and    neck    in   order    to    reduce   a 
subluxated   sixth   cervical   vertebra. 

Torsion  and  Counter  Pressure. — Since  the  cervical 
region  is  normally  very  flexible,  considerable  skill  is  re- 
quired, if  an  operator  makes  use  of  rotation  and  counter 
pressure  for  correction  of  joint  lesions.  The  results  se- 
cured by  these  means  are  very  gratifying,  but  there  is  a 
larger  element  of  danger  than  in  the  use  of  extension.  The 
skillful  operator  must  have  a  good  knowledge  of  the  anat- 
omy of  the  region  and  a  sense  of  tissue  resistance.  A  tor- 
sion movement  is  a  powerful  lever  and  should  be  used 
very  carefully.  Although  it  is  possible  to  describe  the 
relative  positions  of  the  operator's  hands  and  the  general 
direction  of  the  movements,  it  is  not  possible  to  convey  to 
the  reader  an  idea  of  the  amount  of  force  used,  or  the  rela- 
tive amount  of  resistance  to  be  overcome.  It  is  this  var- 
iable element  which  makes  the  difference  between  success 
and  failure  in  operative  work.  Normal  muscle  tone  is 
equal  to  about  six  pounds'  pull,  hence  if  a  patient  volun- 
tarily relaxes,  or  is  placed  in  a  position  which  does  not 


PRINCIPLES  OF  OSTEOPATHY 


487 


FIG.  229.     Position  for  loosening  structures  around  the  atlas 
and  forcing  it  forward. 


PRINCIPLES  OK  OSTEOPATHY 


FIG.  230.  Movement  to  secure  correction  of  a  cervico- 
dorsul  kyphosis.  Many  variations  of  this  leverage  may 
be  used.  The  effectiveness  of  the  movement  depends  on 
the  fulcrum  being  properly  applied. 


PRINCIPLES  OF  OSTEOPATHY  489 

require  any  exertion  to  overcome  gravity,  it  is  very  evi- 
dent that  no  great  amount  of  force  will  be  required  to 
change  the  position  of  an  arthrodial  joint.  If  the  operator 
will  always  bear  in  mind  that  great  force  is  not  required, 
there  will  be  no  accidents. 

Rigidity. — AY  hen  the  patient  holds  his  neck  stiff  and 
rigid,  it  is  necessary  to  determine  why  it  is  so  held  before 
we  attempt  any  movements  to  alter  the  condition.  Disease 
of  the  vertebrae,  or  inflammation  in  the  joints,  is  charac- 
terized by  bilateral  muscular  tension,  which  is  necessary 
to  protect  the  structures  from  the  strain  occasioned  by 
movement.  No  attempt  should  be  made  to  relax  this  ten- 
sion by  manipulation.  The  usual  case  of  "stiff  neck"  is 
unilateral.  It  consists  of  a  unilateral  muscular  contrac- 
tion. Usually  the  patient  cannot  turn  the  head  toward 
the  lesion,  but  can  turn  it  in  the  opposite  direction.  This 
is  the  differential  diagnostic  point  between  a  muscular  and 
a  ligamentous  lesion.  The  ligamentous  lesion  does  not 
permit  rotation  away  from  the  lesion  because  such  action 
stretches  the  ligament. 

The  Favorable  Position  for  Corrective  Movements. — 
As  stated  in  a  previous  chapter,  the  position  of  election, 
for  the  use  of  rotation  as  a  corrective  movement,  is  exten- 
sion. Some  operators  prefer  to  have  the  patient  sitting 
and  thus  have  the  head  balance  its  weight  on  the  vertical 
vertebral  column.  It  is  then  very  easy  to  use  the  weight 
of  the  head  as  an  assisting  factor  in  securing  the  leverage 
necessary  to  correct  slight  rotation  lesions.  By  allowing 
the  patient's  chin  to  rest  in  the  operator's  right  or  left 
hand,  while  the  opposite  hand  supports  the  suboccipital 
region,  Fig.  230,  the  head  may  be  rotated  and  flexed,  or 
extended,  in  such  manner  as  desired  by  the  operator,  to 
correct  a  cervical  subluxation.  The  hand,  which  supports 
the  suboccipital  region,  is  made  to  do  double  duty  by  act- 
ing through  its  lower  border,  as  a  fulcrum,  over  which 
the  spinal  column  is  bent,  so  as  to  accentuate  the  force 


490  PRINCIPLES  OF  OSTEOPATHY 

of  the  corrective  movement  in  a  certain  joint.  The  correc- 
tive rotation  movement  is  always  associated  with  a  little 
flexion  or  extension,  according  to  the  character  of  the 


FIG.   231.     The  use  of  rotation   to  secure  correction  of  cervical  lesions. 


PRINCIPLES  OF  OSTEOPATHY  491 

lesion.  The  head  is  rocked  gently  in  the  direction  required 
for  the  correction  and  when  the  rotation  reaches  a  point 
where  the  resistance  in  the  lesion  is  felt,  Fig.  231,  the  op- 


FIG.  232.    Leverage  and  counter  pressure  applied  to  a  reclining  patient.    Rotation 

is  secured  in  the  upper  dorsal  or  any  point  in  the  cervical 

according  to  the  location  of  the  fulcrum. 


492  PRINCIPLES  OF  OSTEOPATHY 

orator  strives  to  create  a  condition  of  relaxation  by  ad- 
monishing his  patient  not  to  resist,  so  that  by  a  sudden 
but  very  slight  increase  in  rotation  the  lesion  will  receive 
the  full  effect  of  the  movement  and  yield  to  it.  The  yield- 
ing is  usually  accompanied  by  a  clicking-  sound  in  the 
joint  and  a  feeling  of  comfort.  The  ratine  of  voluntary 
movement  in  the  articulation  is  increased  and  the  patient 
usually  experiences  a  feeling  of  added  power. 

The  position  of  the  fulcrum  individualizes  the  charac- 
ter of  a  movement,  therefore  the  shift  of  the  depth  of  one 
vertebra  either  makes  or  mars  the  success  of  one's  effort 
at  correction.  In  order  to  use  the  fulcrum  hand  with  more 
specificity,  or  force,  the  operator  may  rest  the  patient's 
chin  in  the  bend  of  his  elbow  and  then,  by  anchoring' 
the  head  with  his  body,  forearm  and  hand.  Fig.  189,  ex- 
tend the  patient's  neck  by  a  gentle  lift.  This  extension 
frequently  overcomes  enough  of  the  muscular  tension  to 
permit  a  slight  additional  rotation  movement,  with  coun- 
ter pressure,  to  correct  the  lesion. 

Several  illustrations  are  presented  herewith,  to  show 
the  manner  of  applying  the  osteopathic  principle  of  cor- 
recting cervical  subluxations  by  extension  and  torsion. 
The  position  of  the  patient,  either  lying  or  sitting,  is  pure- 
ly arbitrary  with  the  operator.  The  principles  involved  in 
the  operation  are  the  same  in  either  position.  Fig.  232 
shows  how  torsion  and  counter  pressure  may  be  used  when 
the  patient  is  recumbent.  The  position  of  the  right  hand 
illustrates  how  the  influence  of  the  leverage  may  be  car- 
ried into  the  upper  dorsal  region.  Fig.  191  illustrates  the 
application  of  the  same  principle  when  the  patient  is  sit- 
ting. As  we  have  previously  stated,  the  position  of  the 
fulcrum  is  the  part  of  any  corrective  movement,  of  this 
character,  which  localizes  the  effect.  Since  we  are  aiming 
to  change  the  relations  of  the  bony  elements  in  a  flexible 
lever,  the  spinal  column,  at  a  certain  point,  the  fulcrum 
must  be  used  with  reference  to  the  kind  of  movement 
characteristic  at  that  point. 


PRINCIPLES  OF  OSTEOPATHY  493 


CHAPTER  XXIII. 

EXTREMITIES. 

Treatment  of  the  shoulder  for  synovial  adhesions,  liga- 
mentous  or  muscular  contractions,  consists  of  movements 
made  in  the  normal  direction,  but  carried  farther  than  the 
patient  can  do  so  voluntarily. 

Diagnosis. — Test  the  extent  of  the  movements,  normal 
to  the  articulation,  to  ascertain  whether  the  loss  of  move- 
ment is  general  in  all  directions  or  results  from  impair- 
ment of  some  special  muscle  or  ligament. 

Causes  of  Stiff  Joints. — The  history  of  the  case  will 
usually  give  an  insight  into  its  cause,  progress,  etc.  The 
shoulder  articulation  is  frequently  stiffened  by  a  sprain, 
dislocation,  muscular  and  articular  rheumatism.  The 
simplest  cases  are  those  resulting  from  rest,  necessitated 
by  a  broken  clavicle  or  humerus. 

The  necessary  rest  after  a  dislocation  gives  the 
strained  ligaments  an  opportunity  to  shorten  and  thicken. 
Movements  should  be  frequently  forced  in  such  cases  to 
prevent  any  synovial  adhesions.  The  differentiation  of  cases 
of  ankylosis  is  an  important  one.  It  is  disheartening  to 
physician  and  patient  alike  to  find  that  after  weeks  of 
earnest  effort  no  satisfactory  results  are  obtained. 

An  article  on  "Ankylosis"  by  J.  S.  White,  D.  O.,  of 
Pasadena,  Cal.,  published  in  Vol.  V.,  No.  IV.,  of  The 
Osteopath,  page  211,  deserves  quotation  here  because  it 
notes  so  clearly  the  important  points  which  the  student 
ought  to  know.  With  his  permission,  it  is  quoted  in  full. 

"Ankylosis. — When,  from  an  injury,  disease  or  other 
cause,  a  joint  loses  its  function  and  becomes  stiff,  it  is  said 


494 


PRINCIPLES  OF  OSTEOPATHY 


to  be  ankylosed.  This  condition  may  be  termed  bony 
(complete)  or  fibrous  (incomplete),  true  (intra-articular) 
or  false  (extra-articular)  ankylosis." 

"These  are  the  terms  used  by  Da  Costa  to  define 
ankylosis,  yet  some  claim  that  joint-stiffness  caused  by 
extra-articular  contraction,  or  obstruction,  is  not  ankylosis 
in  the  correct  sense;  but  on  looking  at  the  derivation  of  the 
word  (an(^)kulos — crooked  or  bent),  it  seems  that  the 
term  ankylosis  would  be  correct  when  applied  to  any  form 
of  restricted  joint  movement." 

"The  causes  of  ankylosis  are  many.  First,  let  us  con- 
sider those  which  result  in  complete  and  incomplete  an- 
kylosis. Inflammations  in  or  around  the  joint,  from  what- 
ever cause,  if  continued  loni^  enough  for  new  tissue  forma- 
tion, will  cause  ankylosis.  After  aseptic  inflammations  we 


FIG.    233.     Manner   of   applying   leverage    to   stretch    the   structures 
forming   the   scapulo- humeral   articulation. 


PRINCIPLES  OF  OSTEOPATHY 


495 


will  most  likely  find  fibrous,  but  when  there  is  infection, 
bony  ankylosis  is  more  probable." 

"This  fibrous  formation  is  the  result  of  inflammation, 
for  wherever  there  is  inflammation  there  is  an  increase  of 
tissue.  Suppose  a  case  of  dislocation,  with  considerable 


FIG.    234.     A    position    for    easy    manipulation    of    the    scapulo-hu- 
meral  articulation. 


496 


PRINCIPLES  OF  OSTEOPATHY 


contusion  of  the  tissues  around  the  joint,  inflammation  re- 
sults, and  embryonic  tissue  begins  to  form  as  a  reparative 
process;  the  embryonic  tissue  sends  out  small  processes, 
which  start  from  new  centers  and  spread  through  the 
gelatinous  mass,  in  and  around  the  joint,  until  a  very  ir- 
regular network  is  spread  all  around  the  joint  surface, 
when  the  contraction  process  begins,  the  new  tissue  is 
formed  into  fibrous  tissue,  which  unites  the  bones  closely 
together;  by  cicatricial  contraction  the  bones  may  be  drawn 
so  closely  together  that  movement  is  almost  impossible." 

"Bony  union  of  the  joint  surface  follows  fibrous  anky- 
losis  ;  it  occurs  when  the  bone  itself  is  injured  or  diseased, 
and  the  surface  of  the  bone  eroded  or  broken.  Ossification 
begins  chiefly  in  those  layers  of  fibrous  tissue  lying  next 
to  the  bone.'' 

"False  or  extra-articular  ankylosis  is  caused  by  the 
contraction  of  tissues  around  the  joint.  These  contrac- 
tions, external  to  the  joint,  may  be  the  result  of  many 
remote  and  obscure  causes." 


FIG.    235.     Relaxation    of   the   quadriceps    extensor. 


PRINCIPLES  OF  OSTEOPATHY 


497 


"First.  Chronic  contraction,  which  may  be  due  to  dis- 
ease or  obstruction  to  the  nerve,  at  the  center,  or  in  its 
course  to  the  muscles.  As  the  normal  action  of  muscles 
is  dependent  on  normal  nerve  stimulus,  a  muscle  may  be 
affected  in  various  ways  by  the  stimulus  of  an  over-irri- 
tated or  inhibited  nerve ;  excess  of  nerve  stimulation  will 
cause  a  pathological  contraction,  or  there  may  be  suspen- 
sion of  nerve  stimulus  and  paralysis  of  muscles,  allowing 
-the  opposing  muscles  to  pull  and  hold  the  joint  in  a  fixed 
position." 

"Second.  Contractions  sufficient  to  cause  permanent 
fixations  may  follow  the  healing  of  wounds,  ulcers  or  ab- 
scesses. Active  contraction,  from  any  cause,  if  kept  in  that 
state  any  length  of  time,  can  cause  the  muscle  to  undergo 
a  state  of  fibroid  degeneration;  tissue  waste  is  replaced  by 
fat  and  fibrous  material.  There  is  good  evidence  that, 
after  a  time,  tissues  which  have  not  fulfilled  their  function 
lose  the  ability  to  do  so,  and  the  nutritive  changes  ac- 
companying vital  activity  do  not  take  place ;  the  contiguous 
fibers  and  cells  become  adherent,  agglutinated  and  united 


FIG.    236.     Relaxation    of   the   quadriceps   extensor,    sacro-vertebral 
articulation  allowed  to  remain  movable. 


498  PRINCIPLES  OF  OSTEOPATHY 

by  exuded  serum  and  waste  material  not  carried  away  by 
the  circulation,  sluggish  through  inactivity  of  the  muscles." 

"The  tendons  and  ligaments  around  the  joint  are 
thickened  and  hardened  to  the  length  the  limb  was  held 
by  the  active  contraction,  but  after  the  manner  of  all  new- 
ly formed  tissue,  it  continues  to  retract  and  draw  the  limb 
more  out  of  its  normal  position." 

"Third.  Contractions  may  be  the  result  of  certain 
diseases  (as  rheumatism,  gout,  tuberculosis,  syphilis,  or 
any  disease  causing  non-use  of  the  joint  or  mal-nutrition 
of  the  controlling  muscles." 

"In  examining  an  ankylosed  joint,  we  must  distinguish 
between  bony  and  fibrous  ankylosis  and  extra-articular  con- 
traction. A  joint  may  be  immovable,  and  yet  not  so  be- 
cause of  bony  ankylosis." 

"Da  Costa  says  that  a  joint  immovable  from  fibrous 
ankylosis  is  distinguished  from  a  joint  immovable  from 
bony  ankylosis  by  the  fact  that,  in  the  former,  attempts 
at  motion  are  productive  of  pain  and  subsequently  of  in- 
flammation ;  therefore,  pain  on  attempted  motion  excludes 


FIG.    237.     Relaxation   of  the   adductor   muscles  of   the   thigh. 


PRINCIPLES  OF  OSTEOPATHY  499 

bony  ankylosis  from  our  diagnosis.  An  approximate  idea 
of  the  extent  of  the  stiffness  may  be  obtained  from  a  his- 
tory of  the  case  as  to  whether  the  disease  has  been  severe 
in  character  and  long  in  duration.  The  nerves  of  the  joint 
should  be  examined  at  their  point  of  exit  from  the  spine 
and  throughout  their  course  to  the  joint." 

"The  same  conditions,  in  general,  which  cause  pain  in 
a  joint  may  cause  ankylosis,  whether  that  pain  be  due  to 
local  injury  or  referred  from  some  other  part.  A  contracted 
psoas  muscle  by  irritation  to  the  branches  of  the  obturator 
nerve  can  cause  pain,  contraction  and  consequent  stiffness 
of  the  knee  joint." 

"What  can  osteopathy  do  for  this  condition?  For 
bony  ankylosis  nothing  should  be  attempted,  for  the  treat- 
ment would  only  result  in  discouragement  and  disappoint- 
ment to  both  physician  and  patient;  but  if  the  joint  is  in  an 
almost  useless  position,  excision  or  osteotomy  may  be  tried 
with  good  results.  If  the  joint  has  become  ankylosed 
through  septic  inflammation,  it  should  not  be  forcibly 
broken  up,  because  of  the  danger  of  re-infection  of  the 


FIG.   238.     Method   of   stretching   the  sciatic   nerve. 


500  PRINCIPLES  OF  OSTEOPATHY 

whole  joint,  or  other  parts  of  the  body,  through   the  cir- 
culation." 

"In  cases  of  fibrous  and  extra-articular  aukylosis  osteo- 
pathy can  refer  to  the  most  encouraging  records,  and  is  un- 
doubtedly ahead  of  any  other  method  of  treatment.  The 
main  point  in  the  treatment  consists  principally  in  making 
active  the  retarded  circulation,  gradually  breaking  up  the 
adhesions,  thoroughly  relaxing  all  the  muscles,  and  a 
stimulating  treatment  to  the  nerves." 

"For  extra-articular  ankylosis  the  treatment  is  varied 
according  to  the  cause.  Osteopathy  has  a  great  mission 
to  fill  in  finding  and  removing  the  primary  cause  of  many 
cases  of  ankylosis.  Hilton  speaks  of  a  case  of  diseased 
(tubercular)  knee  joint  cured  by  ankylosis.  True !  the 
rest  and  ankylosis  was  nature's  way  of  reducing  the  in- 
flammation and  disease  when  it  had  progressed  so  far. 
But  the  work  of  the  osteopath  is  to  look  for  the  causes 
which  made  the  knee  joint  "a  point  of  least  resistance"  for 
the  tubercle  bacilli  to  multiply  in.  Examine  the  spine 
thoroughly,  the  sacro-iliac  articulation  and  the  hip  for  dis- 
locations, which  cause  pain  in  the  knee  joint  through  irri- 
tation of  the  obturator  nerve.  But  does  pain  alone  in  the 
joints  lead  to  the  condition  known  as  a  'point  of  least  re- 
sistance?' Pain  prevents  much  movement  in  the  joint, 
and  remembering  that  continued  non-use  of  muscles  causes 
mal-nutrition.  sluggish  circulation  and  degeneration  of  the 
muscle,  we  may  see  how  the  joint  may  become  a  place  for 
germs  to  multiply." 

"Is  it  too  long  a  course  from  simple  pain  to  disease? 
Remember  that  pain  is  usually  accompanied  by  contraction 
of  muscle.  Our  treatment  must  be  both  preventive  and 
curative." 

"Following  is  a  case  of  fibrous  ankylosis  and  paralysis 
illustrating  the  efficiency  of  osteopathy  to  treat  this  class 
of  sufferers.  Vincent  Pete,  five  years  of  age,  had  an  anky- 
losed  elbow  as  a  result  of  a  dislocation  and  break.  The 
joint  was  attended  to  immediately  after  the  accident  by  a 


PRINCIPLES  OF  OSTEOPATHY 


501 


regular  physician,  but  was  kept  in  the  splints  too  long, 
which  caused  the  fibrous  ankylosis.  The  humerus  was 
broken  just  above  the  condyles,  and  a  small  spicula  of  bone 
had  protruded  so  that  it  interfered  with  those  fibers  of 
the  median  nerve  which  supply  the  flexor  muscles  of  the 
thumb  and  forefinger  to  such  a  degree  that  the  thumb 
and  forefinger  were  completely  paralyzed,  as  far  as  the 
flexor  movements  were  concerned.  The  forearm  was 
ankylosed  almost  at  a  right  angle  with  the  arm,  and  a  very 
little  movement  could  be  made,  and  that  with  great  pain ; 
the  muscles  in  the  cervical  region  of  the  spine  were  sore 
and  contracted.  This  was  the  condition  of  the  patient 
when  he  came  for  treatment  eight  weeks  after  the  accident. 
The  improvement  began  with  the  first  treatment,  and  in 
on  month  the  arm  was  perfectly  straight  and  movable  in 
any  direction,  and  he  began  to  have  power  of  movement 
in  his  finger  and  thumb ;  at  the  end  of  two  months'  treat- 
ment, his  arm  had  returned  to  almost  its  usual  strength 
and  flexibility.  I  saw  him  a  month  later  and  the  arm  and 


FIG.    239.     Method   of   stretching    the    pyriformis   muscle. 


502  PRINCIPLES  OF  OSTEOPATHY 

hand  were  perfectly  normal.  Contrast  this  case  with  one 
treated  by  mechanical  rest,  resulting  in  a  fixed  elbow  joint, 
or  perhaps  a  moderately  useful  joint  following  forcible 
breaking  of  adhesion  under  anaesthesia,  which  is  a  dan- 
gerous treatment,  with  very  doubtful  results,  as  the  opera- 
tion may  have  to  be  done  over  and  over  again  before  a  use- 
ful joint  is  gained." 

The  Scapulo-humeral  Articulation.  —  Fig.  233  illus- 
trates a  method  of  prying  the  head  of  the  humerus  out  of 
the  glenoid  fossa,  i.  e..  separating  the  articular  surfaces. 
This  movement  can  be  used  in  cases  of  muscular  rheuma- 
tism when  complete  abduction  of  the  arm  is  impossible.  It 
also  allows  an  influx  of  fresh  arterial  blood. 

"When  abducting  the  arm,  the  scapula  must  be  held  by 
the  physician's  hands.  Place  the  fingers  on  the  vertebral 
border  of  tire  scapula,  while  the  axillary  border  is  com- 
pressed by  the  thumb.  l>y  holding  the  scapula  securely, 
the  physician  is  sure  that  all  the  movement  he  forces  is  in 
the  shoulder  articulation,  and  not  the  gliding  of  the  scapula 
on  the  thorax.  The  muscles  of  the  arm  may  be  relaxed  by 
direct  manipulation.  The  insertion  of  the  deltoid  is  fre- 
quently tender.  Any  wasting  of  the  muscles  of  the  ex- 
tremitv  should  be  carefully  noted,  so  that  the  course  of  its 


FIG.     240.     Stretching    the    deep    and    superficial    muscles    on    the 
back    of    the    leg. 


PRINCIPLES  OF  OSTEOPATHY  503 

governing  nerve  may  be  searched  for  a  point  of  com- 
pression. 

Examination  of  the  Brachial  Plexus. — The  principal 
motor  divisions  of  the  brachial  plexus  may  be  tested  by 
simple  movements  made  by  the  patient.  The  patient's 
gripping  power  is  an  index  to  the  condition  of  the  median 
nerve,  and  the  muscles  it  innervates.  Extension  of  the 
forearm,  wrist  and  fingers  made  against  resistance  is  an 
index  of  power  in  the  musculo-spiral  nerve  tract.  Abduc- 
tion and  adduction  of  the  fingers  are  controlled  by  the  ulnar 
nerve.  Flexion  of  the  forearm  by  the  musculo-cutaneous. 

Observe  the  condition  of  the  first  posterior  interos- 
seous  muscle  which  forms  the  little  muscular  swelling  when 
the  thumb  is  adducted  to  the  second  metacarpal  bone.  If 
it  is  wasted  there  is  evidence  of  nerve  cell  degeneration. 
This  muscle  should  be  well  developed  in  thin  hands,  as 
well  as  in  fat  ones.  If  the  wasting  is  unilateral,  look  for 
impingement  on  the  ulnar  nerve  at  some  point  in  its  course. 
If  it  is  bilateral  the  cells  in  the  spinal  cord  are  probably 
at  fault. 

The  deltoid  is  frequently  painful  as  a  result  of  pressure 
on  the  circumflex  nerve.  The  pressure  is  usually  at  the 
point  of  exit  from  the  vertebral  canal.  Relaxation  of  the 
structures  around  its  point  of  exit  usually  gives  relief. 

Reduction  of  Dislocations  by  Traction. — The  general 
method  applied  to  dislocations  of  all  joints  of  the  extremi- 
ties is  direct  traction.  This  is  sometimes  aided  by  pres- 
sure on  the  prominent  point  of  the  dislocated  bone  to  aid 
it  in  slipping  to  its  place.  All  of  the  dislocations  of  the 
humerus,  subcoracoid,  subclavicular,  subglenoid  and  sub- 
spinous,  can  be  reduced  by  using  traction  to  stretch  the 
muscles  and  ligaments  of  the  joint  to  the  extent  that  the 
head  of  the  humerus  will  slip  over  the  rim  of  the  glenoid 
fossa.  This  traction  may  be  made  with  the  patient  sitting, 
as  in  Fig.  234.  The  knee  in  the  axilla  springs  the  head 
of  the  humerus  outward.  The  same  treatment  may  be  ap- 
plied with  the  patient  reclining.  The  physician  should 


504 


PRINCIPLES  OF  OSTEOPATHY 


place  a  ball  of  woolen  yarn  in  the  axilla,  then  place  his 
stockinged  foot  upon  it.  and  make  traction  on  the  arm. 

It  is  possible  to  apply  the  traction  method  in  a  simpler 
way.  An  ordinary  canvas  cot,  with  a  hole  cut  in  it,  so  that 
the  arm  can  be  put  through  while  the  patient  rests  easily  on 
his  side,  should  be  elevated  far  enough  from  the  floor  to  al- 
low a  six-pound  weight  to  be  attached  to  the  wrist.  This 
steady  weight  quickly  relaxes  the  muscles  and  reduces  the 
subluxation. 

Traction  always  strains  the  muscles  and  causes  some 
heat  and  swelling,  therefore,  care  should  be  taken  to  pre- 
vent exudates  and  adhesions. 

Reduction  of  Dislocations  by  Leverage. — Those  who 
are  expert  in  reducing  shoulder  dislocations,  usually  make 
use  of  a  series  of  movements  which  exaggerate  the  lesion, 
i.  e.,  make  the  head  of  the  dislocated  bone  more  prominent. 
In  subcoracoid  dislocations  of  the  humerus,  abduction  of 
the  arm  causes  exaggeration.  The  physician  stands  at 
the  side  of  the  patient,  who  is  reclining  on  a  hard  surface. 
As  abduction  is  made,  the  physician's  free  hand  rests  upon 


FIG.    241.     Position   for  easy  manipulation   of  the   saphenous  opening. 


PRINCIPLES  OF  OSTEOPATHY  505 

the  head  of  the  humerus.  From  the  position  of  abduction 
the  arm  is  carried  inward  and  forward  on  a  level  with  the 
shoulder,  at  the  same  time  being  rotated  internally  so 
that  the  external  condyle  will  be  in  front  of  the  patient's 
nose;  then  carry  the  arm  downward  to  the  side  with  a 
quick,  vigorous  movement,  at  the  same  time  exerting  pres- 
sure on  the  head  of  the  bone  as  before  mentioned.  This 
series  of  movements  must  be  made  quickly,  and  the  pres- 
sure on  the  head  of  the  bone  be  most  intense  while  the  in- 
ternal rotation  and  adduction  are  at  the  maximum 

This  series  of  movements  may  be  employed  to  break 
up  synovial  adhesions. 

Elbow  Dislocations. — Elbow  dislocations  are  infre- 
quent compared  to  those  of  ball  and  socket  joints.  The 
possible  dislocations  of  the  ulna  are  lateral  and  posterior. 
The  former  require  traction,  the  latter  is  reduced  by  placing 
the  bend  of  the  patient's  elbow  over  the  physician's  knee. 
Traction  with  one  hand  on  the  patient's  wrist,  while  the 
other  hand  makes  pressure  on  the  olecranon,  will  force 


FIG.    242.     Position    for   easy   manipulation   of    the   popliteal    space. 


506  PRINCIPLES  OF  OSTEOPATHY 

the  ulna  into  place.  This  dislocation  is  usually  compli- 
cated with  fracture  of  the  coronoid  process. 

The  Radius. — The  radius  may  be  dislocated  posteriorly 
or  anteriorly.  Lateral  dislocations  of  either  radius  or  ulna 
carry  both  bones  together.  A  posterior  dislocation  of  the 
radius  can  be  reduced  by  flexion  of  the  forearm,  then  ex- 
tension with  counter  pressure  on  the  prominent  point  of 
the  head  of  the  radius  posteriorly.  A  forward  dislocation 
requires  stipulation  of  the  arm  and  adduction  of  the  hand, 
together  with  pressure  on  the  anterior  surface  of  the  head 
of  the  radius. 

Dislocations  of  the  bones  of  the  wrist  or  hand  are  re- 
duced by  traction  or  pressure. 

Old  Dislocations. — All  dislocations,  twenty-four  hours 
old.  require  considerable  relaxing  treatment.  The  older 
they  are,  the  harder  they  are  to  reduce.  Nature  begins 
to  adapt  herself  to  new  conditions  almost  immediately. 
All  the  slack  of  muscles  and  ligaments  is  swiftly  taken  up. 
Those  tissues  most  compressed  by  the  new  position  of  the 
bone  are  impoverished  by  the  lack  of  nourishment.  Thick- 
enings and  adhesions  quickly  form,  so  that  old  dislocations 
are  not  easily  handled.  Old  dislocations  are  treated  in 
the  same  manner  as  fresh  ones,  except  that  much  relaxing 
and  restoring  of  vitality  is  necessary. 

Muscles  of  the  Lower  Extremity. — The  muscles  of  the 
lower  extremity  may  be  relaxed,  either  by  direct  manipu- 
lation or  by  taking  advantage  of  the  movement  of  various 
joints  to  put  them  on  a  stretch.  Direct  manipulation  is 
laborious  and  requires  considerable  time. 

The  muscles  of  the  hip  joint  frequently  contract  suf- 
ficiently to  make  walking  difficult.  They  contract  as  a  re- 
sult of  strain,  bruise,  disease  of  the  joint,  subluxation  of 
lumbar  vertebrae,  or  luxation  of  the  iliac  bones.  The  sub- 
luxations  irritate  the  nerves  which  innervate  the  muscles 
controlling  the  joint. 

The  movements  hereafter  outlined  may  be  used  for 
many  different  purposes,  but  they  are  applied  here  to  spe- 


PRINCIPLES  OF  OSTEOPATHY 


507 


cific  groups  of  muscles.  All  the  movements  we  have  thus 
far  outlined  have  been  described  according  to  the  way  they 
affect  structure,  not  function. 


FIG.   243.     Position  for  reduction  of  subluxation   of  external 
semilunar  cartilage  of  the  knee. 


508 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  244.  Showing:  position  for  producing  free  movement 
in  tiie  arthrodial  articulation  between  upper  ends  oT  the 
fibula  and  tibia.  External  popliteal  nerve  lies  behind 
the  head  of  the  fibula. 


PRINCIPLES  OF  OSTEOPATHY  509 

Quadriceps  Extensor. — The  quadriceps  extensor  of 
the  thigh  is  innervated  by  the  anterior  crural  nerve.  In 
order  to  stretch  this  muscle  the  patient  should  lie  face 
downward.  The  physician  grasps  the  patient's  ankle  with 
the  left  hand,  as  in  Fig.  235.  The  right  hand  holds  the 
pelvis  to  the  table.  Lifting  with  the  left  hand  puts  the 
muscle  on  a  tension  which  can  be  easily  increased  by  flex- 
ing the  knee.  This  movement  stretches  the  fascia  over 
Poupart's  ligament  and  the  saphenous  opening. 

Fig.  236  illustrates  a  movement  similar  to  the  pre- 
ceding, but  it  is  not  so  powerful.  When  the  patient  lies 
on  the  side,  his  back  bends  to  the  force  of  the  movement 
of  the  leg.  If  the  physician  grips  the  ankle  instead  of  the 
knee  there  is  a  great  increase  in  the  effect  of  the  move- 
ment. 

The  Adductor  Group. — The  adductor  group  of  thigh 
muscles,  innervated  by  the  obturator  nerve,  can  be 
stretched  as  in  Fig.  237.  If  there  is  any  inflammation  in 
the  acetabulum,  this  movement  will  cause  the  patient 
great  distress,  because  it  stretches  the  teres  ligament. 

Dislocation  of  the  Femur. — Dislocations  of  the  hip 
joint  are  usually  caused  by  the  forcible  spreading  of  the 
legs.  The  head  of  the  femur  is  thus  forced  over  the  edge 
of  the  acetabulum  at  its  dependent  and  weakest  part,  the 
cotyloid  notch.  It  passes  into  the  thyroid  foramen,  and 
if  it  remains  there  all  the  muscles  are  stretched  very  tight- 
ly, and  no  voluntary  movement  is  possible.  The  direction 
the  head  takes  is  dependent  on  the  direction  of  the  force. 
If  the  knee  points  anteriorly  at  the  time  of  the  forced  ex- 
treme abduction,  the  head,  after  entering  the  thyroid  fora- 
men, passes  out  of  it  posteriorly  and  takes  a  position  over 
the  spine  of  the  ischium,  great  sciatic  foramen  or  outer  sur- 
face of  the  ilium,  all  owing  to  the  vigorous  pulling  of  the 
muscles.  If  the  knee  points  posteriorly,  the  head  of  the 
femur  travels  to  a  position  under  the  anterior  inferior  spine 
of  the  ilium. 


510 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  245.  Radiograph  of  fractured  oiecianori  process  and  exudate 
after  removal  of  splints.  Movement  recovered  after  many  weeks 
of  gentle'  manipulation  to  promote  absorption  and  break  ad- 
hesions. 


PRINCIPLES  OF  OSTEOPATHY  511 

The  movements  made  to  reduce  these  subluxations 
take  into  consideration  the  fact  that  the  head  of  the  femur 
must  be  made  to  retrace  its  route  in  order  to  regain  its 
proper  position.  For  example,  a  dislocation  posteriorly  on- 
to the  spine  of  the  ischium  causes  the  toe  to  turn  inward, 
and  there  is  slight  shortening  of  the  leg.  The  physician 
takes  a  position  as  in  Fig.  239  and  carries  the  knee  upward 
and  inward.  He  forces  the  knee  as  far  as  possible  across 
the  median  line,  then  flexes  the  thigh  hard  on  the  abdo- 
men. This  turns  the  head  of  the  femur  downward  and 
inward.  Remember  that  the  head  points  always  in  the 
same  direction  as  the  internal  condyle.  Now,  forcibly  ab- 
duct and  extend  the  thigh  with  a  quick  external  rotation. 
These  movements  cannot  be  made  successfully  without  a 
long  course  of  preliminary  relaxing  treatments,  that  is,  if 
the  dislocation  is  an  old  one. 

Direct  traction  may  be  used  for  all  dislocations  of  the 
femur,  just  as  for  the  shoulder,  but  the  muscles  are  so 
strong  that  it  is  no  small  matter  to  overcome  theTn,  hence 
movements  which  take  advantage  of  leverage  are  much 
more  satisfactory. 

The  formula  for  any  dislocation  of  the  hip  may  be 
worked  out  by  noting  the  position  of  the  head  of  the  femur 
and  then  carrying  the  internal  condyle  so  as  to  make  the 
head  retrace  its  course.  When  shortening  or  lengthening 
of  the  leg  is  noted,  make  sure  that  the  iliac  bones  are  even. 
A  half-inch  difference  in  the  length  of  the  legs  may  easily 
be  accounted  for  by  the  action  of  the  hip  muscles. 

The  pyriformis  muscle  may  contract  and  compress  the 
sciatic  nerve  in  its  course  through  the  great  sciatic  foramen. 
Fig.  239  illustrates  the  movement  to  stretch  the  pyrifor- 
mis. The  physician  holds  the  pelvis  to  the  table  by  press- 
ing on  the  anterior  superior  spine  of  the  ilium.  The  thigh 
is  then  strongly  adducted. 

Stretching  the  Sciatic  Nerves. — Sciatica  is  frequently 
successfully  treated  by  relaxing  the  pyriformis,  but  the 
majority  of  cases  require  a  stretching  of  the  sciatic  nerve, 


512  PRINCIPLES  OF  OSTEOPATHY 


FIO.    24fi.     Position    for   reducing   tarsal    subluxations. 


PRINCIPLES  OF  OSTEOPATHY  513 

which  is  performed  as  in  Fig.  238.  The  physician  has 
great  leverage  in  this  movement.  It  stretches  all  the 
flexor  group  on  the  back  of  the  thigh. 

The  Calf  Muscles. — The  calf  muscles  sometimes  con- 
tract and  make  it  difficult  for  the  patient  to  get  the  heel 
to  the  floor.  Fig.  240  illustrates  the  method  of  applying 
leverage  to  the  case. 

Scientific  Manipulation. — Every  group  of  muscles  in 
the  body  can  be  relaxed  by  stretching  them,  hence  if  the 
student  will  study  their  attachments  and  the  effects  of 
their  normal  contraction,  a  series  of  movements  can  be 
devised  to  suit  the  condition.  Learn  anatomy  in  a  prac- 
tical manner  and  a  system  of  osteopathic  movements  will 
spring  forth  from  the  understanding  mind  of  the  student. 
The  author  has  tried  the  plan  of  not  demonstrating  move- 
ments to  students,  but  putting  the  whole  attention  to  un- 
derstanding the  conditions  in  the  patient  which  require 
treatment.  A  study  of  the  mechanical  difficulties  pre- 
sented and  the  comparison  of  these  with  the  normal  rela- 
tions, leads  the  student  to  apply  anatomical  knowledge  in 
treatment.  If  the  student  understands  the  case,  that  is, 
realizes  the  significance  of  the  points  found  by  the  physical 
diagnosis,  he  can  be  depended  upon  to  apply  a  rational 
method  of  treatment.  As  soon  as  the  student  makes  a 
movement  in  a  certain  manner  in  order  to  copy  his  in- 
structor, instead  of  basing  it  on  his  own  understanding 
of  the  condition  treated,  he  degenerates  to  mere  empirical 
methods. 

Saphenous  Opening. — The  circulation  in  the  lower  ex- 
tremity is  frequently  affected  on  the  venous  side  by  tension 
at  the  saphenous  opening.  Enlargement  of  the  superficial 
veins  of  the  leg,  above  a  point  three  or  four  inches  above  the 
ankle,  denotes  obstruction  to  free  blood  flow  in  the  long 
saphenous  vein.  Abduction  and  tension  of  the  thigh  will 
stretch  the  fascia  forming  the  saphenous  opening,  then 
place  the  thigh  in  a  semi-flexed  position,  as  in  Fig.  241,  to 
facilitate  direct  manipulation  of  the  tissues  forming  this 


514 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  247.  Distension  of  veins  clue  to  tricuspid  insuf- 
ficiency. Varicose  ulcers  on  both  shins  anu  under 
malieoli  of  both  ankles  were  healed  by  strapping 
over  the  ulcers  with  strips  of  adhesive  plaster. 


PRINCIPLES  OF  OSTEOPATHY  515 

opening.  The  deep  and  superficial  veins  of  the  leg  have 
little  or  no  communication  above  a  point  about  the  junction 
of  the  lower  and  middle  third  of  the  leg.  This  applies 
especially  to  the  long  saphenous  vein.  Varicose  veins  on 
the  feet  or  ankles  may  be  drained  by  both  superficial  and 
deep  veins,  therefore,  their  existence  in  these  locations 
may  be  due  to  visceral  causes,  even  when  there  is  no  ob- 
struction to  the  saphenous  opening. 

Popliteal  Space.— The  popliteal  space  sometimes  needs 
relaxation.  This  is  performed  by  direct  manipulation,  as 
illustrated  in  Fig.  242.  The  position  of  the  physician's 
hands  in  this  illustration  affect  the  upper  portion  of  the 
popliteal  space.  By  facing  the  patient  the  lower  portion 
can  be  easily  affected. 

The  Semilunar  Cartilages  of  the  Knee. — These  carti- 
lages, which  serve  to  form  cup-like  depressions  for  the 
condyles  of  the  femur  to  rest  in,  on  the  superior  articular 
surface  of  the  tibia,  may  become  slightly  displaced  and 
hence  act  as  wedges  to  limit  motion  in  the  joint.  Since 
they  normally  move  with  the  condyles,  it  is  probable  that 
some  slight  ligamentous  strain  is  primarily  the  cause  of  the 
change  in  position  of  a  semilunar  cartilage.  The  external 
semilune  is  the  one  most  frequently  affected.  The  reason 
for  this  probably  is  due  to  the  fact  that  the  internal  con- 
dyle  of  the  femur  is  longer  than  the  external,  hence  in  a 
movement,  such  as  pedaling  a  bicycle,  the  extension  of 
the  joint  is  made  with  the  knees  rather  wide  apart.  This 
tends  to  strain  the  external  lateral  ligament.  The  cartilage 
slips  slightly  forward  and  prevents  either  flexion  or  exten- 
sion. The  joint  remains  in  a  semi-flexed  position  and  is 
exquisitely  painful.  Some  of  these  cases  can  be  quickly 
relieved  by  having  the  patient  sit,  so  that  the  operator  can 
grasp  the  knee  with  both  hands,  as  in  Fig.  243.  The  op- 
erator's thumb  makes  careful  pressure  on  the  painful  spot 
where  the  external  semilune  causes  a  little  transverse 
ridge.  By  gently  rotating  the  tibia  and  using  a  slight  ef- 
fort to  slide  the  tibia  on  the  condyles,  without  producing 


516 


PRINCIPLES  OF  OSTEOPATHY 


FIG.  248.  Same  case  as  the  preceding  illustration.  No 
caput  medusae  present,  thus  showing  that  portal  cir- 
culation is  not  seriously  obstructed. 


PRINCIPLES  OF  OSTEOPATHY 


517 


either  flexion  or  extension,  the  semilune  will  tend  to  yield 
to  the  thumb  pressure  and  resume  its  normal  relations  to 
the  condyle.  Since  some  swelling  accompanies  such  an 
accident,  it  should  not  be  expected  that  complete  flexion, 
or  extension,  would  be  possible  immediately  after  replace- 
ment of  the  semilune.  Any  trauma  of  a  ligament  is  ac- 
companied by  the  swelling  incident  to  normal  repair. 

Paralysis  of  External  Popliteal  Nerve. — One  of  the 
most  frequent  forms  of  peripheral  paralysis  involves  the 
Peroneal  or  External  Popliteal  nerve.  Its  position,  with  re- 
lation to  the  fibula,  subjects  it  to  possible  pressure,  when 
one  knee  is  crossed  over  the  other.  It  is  also  subject  to  in- 
jury when  traction  is  made  on  the  leg,  for  a  considerable 
time,  as  is  frequently  done  in  cases  of  hip  joint  injury  or 
fracture  of  the  femur.  Surgeons  realize  the  danger  of  mak- 
ing traction  below  the  knee  joint,  but  there  are  still  enough 
of  these  peripheral  paralyses,  due  to  this  cause,  to  make  it 
evident  that  not  all  physicians  realize  the  danger.  This  form 
of  peripheral  paralysis  is  characterized  by  ankle  drop.  In 
cases  of  Peroneal  paralysis  due  to  pressure,  recovery  is 
nearly  complete  in  a  few  weeks.  This  seems  to  show 


FIG.  249.    'Illustration  of  typical  varicose  veins. 


518 


PRINCIPLES  OF  OSTEOPATHY 


FIG.     250.     Method    of    strapping    with    adhesive    plaster    to 
support   varicose   ulcer   on    the    shin. 


PRINCIPLES  QF  OSTEOPATHY  519 

that  a  slight  edema  exists  in  the  sheath  of  the  nerve  at  the 
point  which  suffered  the  traumatic  pressure.  In  those 
cases  due  to  extension  of  the  leg,  recovery  is  always 
problematical,  because  the  traumatic  pressure  may  have 
been  produced  by  a  fold  of  fascia.  This  is  especially  the 
case  when  the  anterior  tibial  nerve  is  the  only  branch  of 
the  Peroneal,  paralyzed.  These  cases  need  to  be  treated 
by  semi-flexing  the  knee,  so  that  deep  digital  manipulation, 
of  all  the  soft  tissues  of  the  knee,  will  hasten  absorption 
of  the  edema.  Judging  by  some  of  the  cases  we  have  seen, 
the  patients  would  have  been  in  more  capable  condition 
with  bony  deformities,  due  to  fractures,  than  with  the 
paralyses^  resulting  from  the  efforts  to  maintain  reduction 
of  the  fractures.  These  paralyses  are,  however,  unavoida- 
ble in  some  cases,  but  recovery  would  be  more  rapid  and 
certain  if  intelligent  manipulation  was  used  almost  from 
the  beginning  of  the  cases. 

"Glucokinesis  and  Mobilisation." — Many  efforts  have 
been  made  to  develop  a  method  of  treating  fractures,  that 
will  not  only  insure  a  reasonably  perfect  union  but  will 
avoid  the  serious  sequelae  incident  to  the  use  of  casts, 
splints  and  extension  apparatus.  No  single  method  of 
treatment  is  applicable  to  all  forms  of  fractures,  but  there 
are  certain  principles,  underlying  the  art  of  manipulation, 
which  are  applicable  in  the  treatment  of  certain  forms  of 
fractures.  The  use  of  a  form  of  massage,  by  Dr.  Just 
Lucas-Championniere,  in  the  treatment  of  fractures,  is  a 
new  development  in  the  art  of  manipulation.  He  calls 
his  method  "glucokinesis,"  painless  massage.  It  is  so  dif- 
ferent from  massage,  as  generally  understood  by  masseurs, 
that  none  but  physicians,  who  understand  the  phenomena 
in  tissues  involved  in  fracture,  can  use  it  intelligently.  It 
consists  in  stroking  the  injured  part  very  gently,  in  the 
direction  of  venous  circulation  and  the  muscle  fibers.  This 
stroking  is  rhythmical  and  continuous  for  about  fifteen  or 
twenty  minutes.  The  stroking  is  so  gentle  as  to  seem 
quite  ineffective.  The  first  principle  is :  "Never  be  afraid 


520  PRINCIPLES  OF  OSTEOPATHY 

of  rubbing  too  gently,  or  of  giving  too  small  a  dose  of 
mobilisation;  always  fear  that  the  massage  is  too  heavy 
and  the  movement  too  great."  The  result  of  this  stroking 
is  the  relief  of  pain  in  the  injured  part  and  a  coincident 
relaxation  of  the  muscles  involved  in  the  fracture.  This 
relaxation  of  muscles  allows  replacement  of  the  fragments. 
Mobilisation  consists  of  minute  "doses"  of  passive  move- 
ment in  all  of  the  joints  above  and  below  a  fracture.  The 
"dose"  should  cause  no  pain  in  the  limb.  The  applica- 
tion of  Prof.  Lucas-Championniere's  methods  has  been 
excellently  described  by  Dr.  James  B.  Mennell  in  his  work 
on  The  Treatment  of  Fractures  by  Mobilisation  and  Mas- 
sage, MacMillan  and  Co. 

Pain  in  the  Legs  and  Feet. — Many  cases  complain  of 
pain  of  variable  character  in  the  legs  and  feet.  It  is  good 
practice  to  test  the  plantar  arches  in  all  such  c'ases.  Weak- 
ness of  the  longitudinal  arch  may  not  be  evident  except 
when  the  leg  muscles  are  fatigued,  therefore  a  plantar 
impression  may  not  show  any  sagging.  If  no  structural 
defect  is  apparent,  it  is  safe  to  assume  that  weakness 
exists.  The  application  of  strips  of  adhesive,  to  parallel 
the  suspected  tendons,  will  give  enough  support  to  demon- 
strate whether  the  diagnosis  is  reasonably  correct. 

Tarsal  ligaments,  may  be  strained,  or  a  tarsal  bone 
become  subluxated.  The  pain,  incident  to  these  conditions, 
is  very  acute.  Subluxations  are  usually  reduced  by  pas- 
sive movements,  which  merely  tend  to  produce  mobility 
in  the  tarsus  as  a  whole.  If  this  does  not  produce  reduc- 
tion, it  will  be  necessary  to  use  thumb  pressure  over  the 
prominent  painful  spot  and  then  flex  and  extend  the  tar- 
sus with  the  other  hand,  so  as  to  allow  the  pressure  to  be- 
come effective.  In  any  case  of  weak  arch,  or  subluxated 
tarsal  bone,  it  is  advisable  to  use  some  means  of  passive 
support  until  the  acute  phases  are  past.  Some  cases  will 
recover  completely  under  the  influence  of  voluntary  exer- 
cises, while  others  cannot  get  along  without  support. 


PRINCIPLES  OF  OSTEOPATHY  521 

Varicose  Veins. — The  pain  incident  to  varicose  veins 
may  be  very  severe.  The  first  thing  to  determine  is 
whether  the  varicosity  is  due  to  local  or  general  condi- 
tions, i.  e.,  whether  there  is  involvment  of  one  group  of 
veins  in  a  single  extremity,  or  a  general  back  pressure 
in  all  the  veins  of  the  body,  due  to  a  lesion  in  the  right 
auriculo-ventricular  valves,  or  muscular  insufficiency.  The 
varicosity  due  to  pregnancy  is  in  a  class  of  its  own.  The 
veins  on  the  shin  lie  so  close  to  the  surface  that  a  very 
slight  abrasion  causes  a  varicose  ulcer.  The  weight  of  the 
column  of  blood,  in  the  long  saphenous  vein,  serves  to 
break  down  the  granulations  by  which  healing  tends  to 
take  place.  In  such  cases,  whether  due  to  local  or  systemic 
conditions,  it  is  best  to  furnish  the  vein  an  artificial  sup- 
port by  strapping  with  strips  of  adhesive  plaster  directly 
over  the  ulcer  and  for  a  space  of  three  inches  on  all  sides 
of  it.  These  strips  should  be  about  one  inch  wide  and 
lapped  on  to  each  other  about  one-quarter  inch,  as  in  Fig. 
250.  This  artificial  support  should  be  left  in  place  three 
days,  then  be  stripped  off,  the  ulcer  cleansed  and  fresh 
adhesive  applied.  The  amount  of  exudate  will  decrease 
rapidly  under  this  treatment.  Previous  to  the  first  dress- 
ing, there  should  be  no  application  of  irritating  antisep- 
tics. The  mechanical  principle  of  supporting  the  wall  of 
the  vein  is  all  that  is  necessary.  The  moisture  of  the  ulcer 
will  keep  the  adhesive  from  breaking  the  granulations  as 
it  is  pulled  off.  As  soon  as  the  discharge  from  the  ulcer 
ceases  there  is  no  necessity  for  removing  the  adhesive  for 
many  days.  In  the  meantime  such  general  help,  as  may 
be  possible,  should  be  given  to  overcome  the  conditions 
which  predispose  to  a  recurrence  of  the  ulcer. 


522  PRINCIPLES  OF  OSTEOPATHY 


CHAPTER  XXIV. 

MANIPULATION  FOR  YASO-MOTOR  NERVE 
EFFECTS. 

There  are  times  when  the  physician  desires  to  affect 
the  amount  of  blood  in  the  tissues  of  the  head.  There  may 
be  congestion  of  the  nasal,  pharyngeal  and  laryngeal  mu- 
cosa,  as  during  a  hard  "cold."  After  manipulating  to  re- 
lax the  muscles  of  the  neck  and  overcome  any  effects  these 
may  have  had  on  the  position  of  the  cervical  vertebrae,  it 
is  well  to  try  to  cause  vaso-constrictor  action  by  stimulat- 
ing nerve  endings.  Fig.  251  illustrates  a  method  of  stimu- 
lating deeply  under  the  zygoma  in  the  sigmoid  notch  of 
the  inferior  maxillary  bone.  \Yhen  the  patient  opens  his 
mouth,  the  physician  places  his  finger  over  the  depression 
below  the  zygoma  and  presses  inward,  at  the  same  time 
making  a  vibratory  movement  of  the  finger.  This  affects 
the  branches  of  Meckel's  Ganglion  and,  through  it,  the 
nasal  mucosa.  It  is  a  painful  treatment,  but  the  blood 
will  often  surge  from  the  mucous  tissues  to  the  skin  as  a 
result  of  it. 

About  the  same  effect  is  secured  by  using  the  move- 
ment illustrated  in  Fig.  252.  While  the  patient's  mouth 
is  open,  the  physician  places  his  thumbs  on  the  bridge 
of  the  nose,  and  his  fingers  at  the  angles  of  the  jaw.  The 
tips  of  the  little  and  ring  fingers  are  pressed  into  the  de- 
pression caused  by  the  forward  movement  of  the  condyle 
of  the  jaw  on  the  eminentia  articularis.  The  physician 
forces  the  mouth  shut  while  the  patient  opposes.  The 
position  of  the  tips  of  the  little  and  ring  fingers  prevents 
the  easy  slipping  of  the  condyles  into  the  glenoid  fossa. 


PRINCIPLES  OF  OSTEOPATHY 


523 


The  sensory  fibers  around  the  condyle  are  intensely  stim- 
ulated and  frequently  manifest  it  by  spreading  a  flood  of 
color  over  the  face  in  front  of  the  ear.  This  is  also  a  pain- 
ful stimulation.  It  is  highly  probable  that  all  movements 
of  this  character  which  are  painful  secure  results  by  caus- 
ing activity  of  the  dilator  nerves  to  blood  vessels  in  super- 
ficial tissues,  thus  depleting  the  blood  in  the  congested 
area.  A  sharp  pain  may  cause  a  sudden  blanching,  but  it 
is  followed  by  vaso-dilation. 

If  it  is  difficult  for  the  patient  to  breathe  through  the 
nostrils,  press  on  the  nasal  bones,  first  on  the  right  side, 
then  left,  then  make  a  heavy  pressure  over  the  junction  of 
the  nasal  and  frontal  bone  with  one  thumb  above  the  other. 
This  movement  is  very  pleasant  to  the  patient,  ordinarily. 

To   carry  off  the   venous   blood,   make   a   stroke   from 


FIG.  251.     Stimulation  between  the  zygoma  and  the  sigmoid  notch 
of  the   inferior  maxilla. 


524 


PRINCIPLES  OF  OSTEOPATHY 


the  inner  canthus  of  the  eye  downward  over  the  junction 
of  the  masseter  muscle  with  the  lower  jaw,  thence  to  the 
supraclavicular  fossae. 

The  Fifth  Cranial  Nerve. — The  fifth  cranial  nerve  can 
be  treated  at  its  points  of  exit  through  the  bones  of  the 
face.  Fig.  253  illustrates  the  position  of  these  points.  A 
vibratory  pressure  over  these  points  causes  a  dull  but  in- 
creasing pain.  If  the  movement  is  made  quickly  and  vig- 
orously, there  will  be  evidence  of  a  reaction  in  a  flushed 
appearance. 

Inhibition  of  Suboccipital. — When  there  is  a  high 
blood  pressure*  in  the  head  and  the  patient  is  suffering 
with  headache  it  is  possible  to  give  great  relief  by  steadily 
inhibiting  in  the  suboccipital  fossae  and  temples,  as  illus- 


FIG.    252.     Stimulation    by    forcible    closure    of    the    mouth    against 
resistance. 


PRINCIPLES  OF  OSTEOPATHY 


525 


trated  by  Fig.  254.  All  nervous  conditions  are  greatly 
reduced  by  this  mdvement.  The  inhibition  reduces  the 
number  of  sensory  impressions,  and  lessens  the  tension  of 
blood  vessels  all  over  the  body.  This  inhibitory  move- 
ment should  be  used  in  cases  of  epilepsy  and  delirium  tre- 
mens  during  the  excitable  stages.  Have  an  assistant  in- 
hibit in  the  splanchnic  area,  thus  causing  a  general  reduc- 
tion of  blood  pressure  in  the  superficial  and  deep  tissues 
of  the  body  and  extremities.  The  blood  is  thus  drawn 
away  from  the  head,  and  the  patient  becomes  quiet. 

To  inhibit  the  transmission  of  impulses  to  the  dia- 
phragm by  the  phrenic  nerves,  pressure  should  be  made 
as  in  Fig.  255.  The  physician's  fingers  compress  the  phrenic 
nerve  against  the  scalenus  anticus. 


FIG.   253.     Points  of  exit  of  divisions  of  the  fifth  cranial  nerve. 


526 


PRINCIPLES  OF  OSTEOPATHY 


The  phrenic,  pudic  and  pneumogastric  are  the  only 
nerve  trunks  distributed  in  the  body  which  can  be  easily 
compressed  through  soft  tissue.  Fig.  256  illustrates  stim- 
ulation of  the  pneumogastric.  The  physician's  ringers  roll 
over  the  nerve  trunk  where  it  lies  along  the  inner  edge 
of  the  sterno-cleido-mastoid. 

The  general  tendency  of  an  osteopathic  treatment, 
which  aims  to  relax  the  extensor  muscles  of  the  neck  and 
trunk,  is  to  reduce  blood  pressure.  Cases  which  are  char- 
acterized by  high  blood  pressure  are  greatly  benefited  by 
relaxation  of  muscle  tension,  by  means  of  gentle  leverage. 
The  use  of  heavy  pressure  movements  is  contraindicated, 
because  they  might  occasion  involuntary  resistance  by  the 
patient  and  thus  suddenly  raise  blood  pressure  to  a  dan- 
gerous degree. 

It  is  very  probable  that  the  extension  and  counter 
pressure  movements  we  use  to  reduce  subluxations,  act  also 


FIG.    254.     Inhibition    in    the    suboccipital    fossa. 


PRINCIPLES  OF  OSTEOPATHY  527 

as  factors  in  changing  blood  pressure  in  localized  visceral 
areas. 

Vaso-motor  effects  can  be  secured  by  various  forms 
of  stimulation  applied  to  spinal  areas.  Counter  irritation, 
cupping,  heat  or  cold,  concussion,  or  sudden  pressure  to 


FIG.   255.     Inhibition   of   the   phrenic  nerves.     Center  for  hiccough. 


528 


PRINCIPLES  OF  OSTEOPATHY 


the  point  of  producing  a  "click"  in  an  arthrodial  joint,  all 
produce  vaso-motor  effects  of  various  degrees.  They  all 
serve  a  useful  purpose  and  tend  to  reinforce  each  other  in 
some  cases. 


FIG.    256.     Stimulation   of   the    pneumogastric    nerves. 


PRINCIPLES  OF  OSTEOPATHY  529 


BIBLIOGRAPHY 


On  Bone  Setting W barton  P.  Hood 

Theory  of  Osteopathy Riggs 

Physiology  of  Bodily  Exercise La  Grange 

Principles   of   Osteopathy • Hulett 

Principles    of    Osteopathy Hazzard 

Practice  of  Osteopathy Hazzard 

Practice  of  Osteopathy McConnell  and  Teall 

Lateral  Curvature  of  the  Spine  and  Round  Shoulders 

Lovett 

The  Development  of  the  Human  Body McMurrich 

Technique  Rigsby 

Autobiography  A.  T.  Still 

Philosophy  of  Osteopathy A.  T.  Still 

Philosophy  and  Mechanical  Principles  of  Osteopathy 

, A.  T.  Still 

Osteopathy,  Research  and  Practice A.  T.  Still 

Pain  Schmidt 

Pulmonary  Tuberculosis   : Pottinger 

Orthopedic  Surgery  Whitman 

Studies  in  the  Osteopathic  Sciences.  Vols.  I,  II,  III 

; _ Burns 

The  Integrative  Action  of  the  Nervous  System...Sherrington 

Diagnosis  and  Treatment  of  Diseases  of  Women Crossen 

Immunity  Citron 

Applied  Anatomy Bardeleben 


530  PRIXCIPLKS  OF  OSTEOPATHY 

Physiology  of  the  Nervous  System Morot 

Text  IJook  of  Physiology Howell 

Treatment  of  Fractures  by  Mobilisation  and  Massage 

Mennell 

Spondylotherapy \brams 

Hand  Atlas  of  Human  Anatomy Spalteholz 

Eye  Strain  in  Health  and  Disease Ranney 

Abdominal    Pain Maylard 

The  Abdominal  and  Pelvic  P>rain Robinson 

Diseases  of  the  Xervous  System  Resulting  from  Acci- 
dent and  Injury  ; Bailey 

Modernized  Chiropractic Smith,  Langworthy,  Paxson 

Surgical  Anatomy Campbell 

Clinical  Anatomy  Eisendrath 

A  Manual  of  Medicine Allchin 

Manual  of  Physiology Stewart 

Kirke's  Handbook  of  Physiology Kirke 

Diseases  of  the  Xervous  System Mettler 

Biology.  General  and  Medical McFarland 

Applied  Anatomy Clarke 

Xormal  Histology  Piersol 

Comparative  Physiology  and   Morphology  of  Animals 

Le   Conte 

Xeurotic  Disorders  of  Childhood Rachford 

Anatomy  of  the  Central   Xervous  System  in   Man  and 

in  Vertebrates  in  General Edinger  and  Hall 

Bier's  Hyperaemic  Treatment Meyer.  Schmieden 

Physiologic  and  Pathologic  Chemistry Bunge 

( )rigin  of  Life  Le  Dantec 

Manual  of  Osteopathic  Gynecology \Yoodall 


PRINCIPLES  OF  OSTEOPATHY  531 

Deformities    including    Diseases    of    the    Bones    and 

Joints  Tubby 

The  Treatment  of  Fractures Scudder 

Principles  of  Surgery Nancrede 

Lectures  on  Rest  and  Pain Hilton 

ARTICLES 

Rotary  Lateral  Curvature.    No.  7,  Vol.  II  of  J.  of  A. 

O.  A H.  W.  Forbes 

The    Nature   of   a   Subluxation.    No.   5,   Vol.   I,  J.   of 

A.  O.  A _ Tasker 

How  the  Heart  is  Affected  by  Osteopathic  Manipula- 
tions.   No.  11,  Vol.  II,  J.  of  A.  O.  A Tasker 

Vertebral    Articular    Lesions.    (Series   begun    in    1908) 

J.  of  A.  O.  A Forbes 

Auto-Protective   and    Recuperative   Mechanism   of  the 

Body.    No.  4,  Vol.  XI,  J.  of  A.  O.  A E.  S.  Willard 

The  Osteopathic  Lesion.     No.  8,  Vol.  IX,  J.  of  A.  O. 

A ! McConnell 

The  Immediate  Effects  of  Bony  Lesions.     No.  11,  Vol. 

IX,  J.  of  A.  O.  A Burns 

Examples  of   Functional    Lesions.     No.   9,   Vol.   X,    I. 

of  A.  O.  A H.  F.  Goetz 

Adaptation  and  Compensation.  No.  3,  Vol.  Ill,  West- 
ern Osteopath  Tasker 

Backache.     California  State  Journal  of  Medicine,  June 

and  July,  1909 C.  M.  Cooper 

A  Consideration  of  the  Pelvic  Articulations  from  an 
Anatomical,  Pathological  and  Clinical  Standpoint. 
Boston  Medical  and  Surgical  Journal,  May  18  and 
June  1,  1905 Goldthwait  and  Osgood 


INDEX 


NOTE — Main  chapter  subjects  are      referred  to  in  dark  faced  numerals. 

Cartilages,  Semilunar  of  knee 373 

Cause  and  effect 33 

Causes  of  disease 27 

Causes  of  disease,  Difference  in 

.    belief  as  to 29 

Cell    life    dependent   on    circula- 
tion   35 

Cell  relations  34 

Center,  Bladder  235 

Cardiac  154,  156,  158 

Chills  227 

Cilio-spinal  136,  223 

Defecation  233 

Gall  bladder  229 

Heart 223 

Intestines    225,  227,  229 

Kidneys    233 

Liver  225 

Lung  , 220 

Micturition    233 

Osteopathic  194 

Ovary   231 

Parturition 233 

Spleen  225 

Stomach  225 

Testes  231 

Uterus 229 

Vaso-motor  167 

Cervical  region,  Affections  of....  66 

Extension    474 

Rotation  475 

Chorea    358 

Circulation    149 

Circulation    apparatus 151 

Capillary    166 

Cell  life  dependent  on 35 

Influence  on  49 

Clavicles   309,  471 

Compensation  332 


Page 

Abdomen  395 

Acceleration    354 

Adaptation   28,  332 

Adaptation,  Failure  of 42 

Adhesions,  Synovial  372 

Alignment  and  flexibility 385 

Anaesthetic,    inhibition 368 

Anatomy    183 

Angina  pectoris  158 

Ankylosis  493 

Articulation,   Atlo-axial 294 

Costo-central 304 

Costo-transverse   304 

Dorso-lumbar  302 

Lumbo-sacral   .".264,  266,  268 

Occipito-atlantal    286 

Sacro-iliac   269 

Scapulo-humeral    502 

Articulations,  Ankylosis  of 493 

Arthrodial,  enarthrodial  376 

Sounds  produced  in 371 

Structure   of  285 

Tarsal 520 

Atlas,  The  ... 285,  479 

B 

Back    239,  325,  379 

Back,  Inspection  of  the 45 

Backache  , 311,  378 

Blood    149 

Bone-setting  374 


Cardiac  plexus  141 

Caries  294,  319 

Carpal  subluxations  375 


INDEX 


Page 

Compensation  curvature 335 

Conductivity   98 

Contraction,  Muscular 354 

Control,  Plurisegmental 1 10 

Co-ordination,    Segmental 50 

Curvature,    Compensatory 335 

Lateral    .  69,  40X,  440 


D 


Development,    Variations   in 43 

Diagnosis  195,  381.  386,  392.  493 

Diagnosis,    Backache 311 

Extremities   493 

Osteopathic  ..  ..  23 

Physical  ...  ....23,  185 

Digastric    '. 476 

Disease.   Causes   of 27 

Interpretation    of    phenomena 

of    29 

Known    causes   of 30 

symptoms    32 

Dislocations    503 

Dislocations,     Klbow 505 

Femur  509 

of  radius  506 

Old  ....505 

Dorsal  region,   Irritation  in. .67,  380 


E 


Efficiency  28 

Elbow,  Dislocations 505 

Embryology    88 

Encysting,   Power  of 339 

Environment,     Eavorable     reac- 
tion   to    30 

Erector  spinae  412 

Examination,  Position  for 384 

Ex  tension 474 

Extension,  Spinal   250 

Extremities   ..  ....341,  400,  493 


Page 
F 

Eatigue,    Effect   of....  ....41,  357 

Ecct  ..  342 

Eeet,   Pain    in....  520 

Femur,    Dislocation    of 509 

Fever  122 

Fever,     Infectious 326 

Flexion,    Spinal....  250 

Fracture,    Mobilisation 353,  519 

Fulcrum,    The    use    of 432 

Function,   Impairment  of 361 

and    structure   39 

Variations  in  ...  .  27 


Ganglia,  Automatic  visceral 148 

Sympathetic  127 

Ganglion,  M eckel's 522 

Superior  cervical 205,  293 

Gluco-kinesis    and    mobilisation. .519 

H 

Headache  ..  132 

Head's   law   .  191 

Healing,  The  true  art  of 39 

Health  25 

Health,  Normal  ..  28 

Heart   153,  337 

Herpes  Zoster  187 

H  iccough   213 

Hilton's   law   .  181 

Hyoglossus   476 

Hyoid  bone  476 

Hyperacmia   73,   170 

Hyperaestliesia,    Spinal. .59,  365,  392 
1  lypogastric    plexus 146 


Inefficiency    29 

Inflammation,    Serous    mem- 
branes   328 

Inhibition  ...  ....354 


INDEX 


Page 
Inhibition,  Dosage  360 

Therapeutic  362 

Innervation,  Influence  on 49 

Inspection  114,  386 

Integration,  Segmental 103 

Systems  of  99 

Irritability  ,.  97 

Irritation,  Mechanical 100 

K 

Kidneys    338 

Knee  183,  515 

Kyphosis    

413,  419,  422,  425,  427,  450,  451 

Kyphosis,  Lower  dorsal 302 


Larynx,   Intrinsic  muscles  of 478 

Latissimus    dorsi.    Manipulation 

of   406 

Law  of  compensation 341 

Head's  191 

Hilton's  181,  362 

Legs,  Pain  in 520 

Lesion  an  objective  symptom....  57 

as  a  cause 40 

Causes  of  41,  75 

Characteristics   of 40 

Classes  of  41,  56 

Disease    association 31 

in    diagnosis 76 

integration  120 

palpation    44 

patterns    58 

Persistence    of 43 

Secondary    41,  56 

Sequence   of  43 

Spinal    82,  91,  450 

Traumatic    47 

Twelfth  rib  407 

Lesions,   Autotoxemia   in 120 

Chemical   causes   of....  ...  42 


Page 

Depth  and  extent  of 119 

Experimental    52 

False  297 

Functional    fatigue 112 

Group   110 

History  of 400 

Leverage  419,  448 

Life,  Tenacity   of 31 

Lordosis    416,  419 

Lumbago   323 

Lumbar   region,   Irritation   in 68 

Lumbo-sacral    articulation 

264,  266,  268 

Lymph    149 

M 

Malignant  growths  322 

Manipulation   133.  402 

Manipulation,    Back 379 

Chiropractic 404 

Conservative  vs.  radical 383 

Corrective  434,  484 

Dislocation    503 

Dislocation  of  elbow 505 

Dislocation,    Old 506 

Dorsal 380 

Extension  478 

External   popliteal   nerve 517 

Fifth  cranial  nerve 524 

General  principles 483 

Gluco-kinesis    403 

Gluco-kinesis  and  mobilisation519 

Head  and  neck 378,  419 

Kyphosis  413,  422,  425,  427 

Lordosis 416 

Methods  of  procedure 404 

Mobilisation    403 

of  adductor  muscles  of  thigh..509 

of  ankylosis    493 

of  atlas  479 

of  cervical  region 471 

of  clavicle    471 

of  digastric  476 


INDEX 


Page 
Manipulation — 

of  erector    spinae 412 

of  extremities  493 

of  femur    dislocation 509 

of  hyoglossus  476 

of  larynx    478 

of  latissimus    dorsi 406 

of  mylo-hyoid    476 

of  pectoralis    major 410 

of  phrenic   nerve 525 

of  popliteal   space 515 

of  pyriformis  muscle 511 

of  quadratus    lumborum..407,  411 

of  quadriceps   extensor 509 

of  rhomboids    409 

of  rib    subluxations 452 

of  sacro-iliac  subluxations 461 

of  scaleni  473 

of  scapulo-humeral       articula- 
tion     502 

of  serratus    magnus 410 

of  splenius  capitis  et  colli 

421,  473 

of  sterno-cleido    mastoid 472 

of  sterno-hj'oid    477 

of  sterno-thyroid  477 

of  stylo-hyoid  476 

of  subluxations    443 

Position    for 489 

Rigidity,    cervical    region 489 

Rotation,  cervical  region 475 

Saphenous    opening 513 

Scientific    513 

Semilunar  cartilages,  knee 515 

Stretching  sciatic   nerve 51 1 

Suboccipital    nerve    524 

Swedish    402 

Tarsal  ligaments ..520 

Torsion  and  counter  pressure. .486 

Traction   503 

Varicose  veins  : 521 

Vaso-motor  effects 522 

Massage  ....402 


Page 

Meckel's  ganglion 522 

Medicine.    Practice   of 17 

Preventive  31 

Schools  of....  ....430 

Membranes,      Inflammation      of 
serous    328 

Mobilisation    and    gluco-kinesis..519 

Motion,    Loss   of 54 

Muscle.    Crico-thyroid 478 

Digastric    476 

Erector  spinae....  .  ..412 

Hyoglossus  476 

Irritability   of 97 

Latissimus     dorsi.     Manipula- 
tion of  ..  406 

Mylo-hyoid    476 

Pectoralis   major....  410 

Pyriformis  51 1 

Quadratus   lumborum 407,  411 

Quadriceps    extensor 509 

Rectus  capitis  anticus  minor....292 

Rectus   lateralis 291 

Rhomboids    409 

Scaleni    473 

Serratus  magnus 410 

Sphincter  vaginae 237 

Splenius  capitis  et  colli. ...21 5.  421 

Sterno-hyoid  477 

Sterno-thyroid    477 

Stylo-hyoid    476 

Trapezius    215,  408 

Muscles.  Adductor  of  the  thigh. .509 

Association    of 92 

Cervical    87 

Developmental    changes    in 93 

Xervous   distribution   to 184 

of  lower  extremity 506 

of  the  back 392 

Muscular  contraction 299,  354 

tension  59,  73.  75.  394 

tone.  Loss  of 51 

Mylo-hyoid   ..  ....476 


INDEX 


N 

Page 

Neck,  Examination  of 398 

Manipulation  of 378 

Nerve  bundle 101 

cells,    Central 86 

fibres,  Afferent  and  efferent....! 00 

fibres,   Intraspinal .-. 101 

Hypoglossal    205 

Intercostal  189 

Phrenic    213,  525 

Pneumogastric.-lS4,  199,  472,  526 

Posterior  thoracic 78 

Spinal  accessory 213,  472 

Splanchnic  138 

tissue,  Attributes  of 355,  358 

of   Wrisburg 220 

Nerves,  Brachial 217 

Cervical  197,  217 

External    popliteal 517 

Fifth   cranial 524 

Pudic  526 

Sciatic  511 

Sensory    164 

Suboccipital    524 

Vaso-motor  160 

Nervous   system 61,  97 

Sympathetic    125 

Neuralgia 61 

Neurotic   diathesis 358 

Normal  and  abnormal 27 

Variation    of....  ..  28 


O 


Osteopathy   403 

Osteopathy,  Definition  of 19 

Founder   of  18 

Growth   of 17 

Name    25 

Scope    of 24 


Pain 


Page 
.122,  311,  520 


Pain,    Colicy 329 

Referred  visceral 326 

Palpation 23,  74,  296,  386,  453 

Palpation     of     vertebral     struc- 
tures      45 

Paralysis    agitans 358 

Paraplegia    234,  322 

Patterns,    Reflex 331 

Pectoralis  major 410 

Pelvic   plexus 146 

Pelvis    263 

Pleurisy  58,  409 

Plexus,  Brachial 217,  503 

Cardiac  141 

Cervical    .., 21 1 

Hypogastric    146 

Lumbar    235 

Pelvic    146 

Pulmonary    142 

Sacral   235 

Solar   144 . 

Subsidiary   147 

Poise  .: 312 

Popliteal    space 515 

Position  for  examination 384 

Posture  '. 323 

Pott's  disease  451 

Pressure,  Inhibitory  effect  of 359 

Tenderness    to 46 

Principles,  Application  of-. ..431,  440 

Corrective    movements 483 

Prostate  gland 398 

Pulmonary  plexus 142 

Pyriformis  511 


Quadratus    lumborum,    Manipu- 
lation  of 407,  411 

Quadricep    extensor 509 


INDEX 


R 

Page 

Rachitis    320 

Radius.    Dislocation    of 505 

Reactions,   Intensity  of 330 

Protective  105.  121 

Recovery,    Xatural 37 

Rectum,    Examination   of 393 

Recumbency,  Effect  of 68 

Recuperative   power,    Inherent....  38 

Reflex    patterns 331 

subluxations    330 

Reflexes    105.  114 

Reflexes.   Intensity   of 213 

Location  of 330 

Visceral    57 

Region,    Cervical 243,  471,  489 

Cervical  extension 474 

Cervical    rigidity 489 

Dorsal    248,  255 

Interscapular  135.  220 

Lumbar  249,  259.  302 

Resistence,  A  change  of 33 

Respiration,  Xervous  control  of.. 306 

Rest  189 

Rest,    Physiological 49 

Rhomboids    409 

Ribs,  Examination  of 304,  396 

Rigidity    489 

Rotation,    Cervical    region 474 

Dorsal  440 

Spinal  ..  ...250,  261 


Sacral  region.  Irritation  in 68 

Sacro-iliac    articulation 269 

Saphenous    opening 513 

Scaleni    473 

Scapula    219,  408 

Sciatic   nerve.   Stretching 511 

Secretion 354 

Segmental    co-ordination 109 

Segmentation    105 


Page 

Segmentation  of  the  body 76 

of  the  spinal  cord 101 

Semilunar  cartilages  of  knee 515 

Sensation   117 

Sensation,   Reception  of 109 

Sensory  nerves 164 

Serous      membranes.      Inflamma- 
tion in 328 

Serratus  magnus 410 

Shock    357 

Skin  338 

Solar   plexus 144 

Spinal  alignment  and  flexibility..385 

arthropathies    320 

column  ... 239,  333 

cord   326 

curvature    318 

curves   264 

curves,  Normal  242 

extension    250 

flexion  242 

hyperaesthesia    59,  64,  378 

irritation.   Symptoms   of 64 

ligaments  239 

nerves.  Irritation  of 60 

rigidity    320 

rotation   250,  316 

treatment  60 

Splanchnic  nerves 138 

Spondylitis   deformans 320 

Splenius  capitis  et  colli 421,  473 

Statics  312 

Sterno-cleido-mastoid    472 

Sterno-hyoid  477 

Sterno- thyroid    477 

Structure,    Necessity    for    study 

of   54 

Variations    in    27 

Stylo-hyoid    476 

Subluxation,    Atlas 479 

Carpal   ..  375 

Clavicle  ...  ....471 

Lateral   ..  ...298.  443,  450 


INDEX 


Page 
Subluxation — 

Reduction    of 443 

Sacro-iliac  269,  316,  461 

Tarsal    375,  520 

Subluxations  283 

Costal    307,  452 

Innominate  bones 461 

Reflex   330 

Suboccipital    triangles 209 

Subsidiary   plexus 147 

Surgery 24 

Sympathetic,  Ganglia  of 70 

nervous    system 125 

Symptoms,  Objective  118 

Subjective  59,  401 


Page 

Trapezius    408,  471 

Trauma  325 

Treatment  85 

Triangles,   Suboccipital 209 

Trophicity  98 

Tumor  322 

Typhoid    spine 323 

U 

Ulcer,  Varicose  521 

Unity,  of  the  body 58 

of  the  nervous  system 99,  125 


Tarsal   subluxations 375 

Tension,    Arterial 1 52 

Intracellular    35 

Muscular    59 

Testing  alignment  and  flexibility  384 

Therapeutics    173,  185 

Osteopathic  24 

Scientific  36 

Thorax    335,  395 

Tissue  relations,  Disturbed 38 

Torsion  486 

Toxemia  323 

Traction,  Femur  dislocation 509 


Vaso-motion  215 

Vaso-motor  nerves 160,  362,  522 

Veins,  Varicose 521 

Vertebra,  Fifth  lumbar 263 

Sixth  cervical.. 481 

Vertebrae,  Cervical : 295 

Lower  dorsal 302 

Violence,  Effect  of 41 

Viscera  192 

Viscera,  Plurisegmental  control 

of 329 

Visceral  disturbance 63 

ganglia    148 

pain,  Referred 326 


t  "7   ~ 


'  "V 


Date  Due 


A  OOP  499  589 


WB9UO 
T198p 

1913 
Tasker . 

Principles  of  osteopathy 


UCI  CCM  LIBRARY 


